Provider Demographics
NPI:1376274696
Name:BRIDENT DDS PC
Entity Type:Organization
Organization Name:BRIDENT DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-571-3104
Mailing Address - Street 1:530 S MAIN ST STE 600
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4544
Mailing Address - Country:US
Mailing Address - Phone:714-571-3104
Mailing Address - Fax:
Practice Address - Street 1:8449 GULF FWY STE C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77017-5044
Practice Address - Country:US
Practice Address - Phone:713-649-8590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG60850Medicaid