Provider Demographics
NPI:1366671562
Name:DEYOUNG, BRIDGET ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:ANN
Last Name:DEYOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRIDGET
Other - Middle Name:ANN
Other - Last Name:DEYOUNG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1921 MOUNT KILIAK CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-9727
Mailing Address - Country:US
Mailing Address - Phone:410-404-2850
Mailing Address - Fax:
Practice Address - Street 1:4341 TUDOR CENTRE DR STE 100
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-729-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1042761223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics