Provider Demographics
NPI:1407156789
Name:BRIDI, CHADI (DDS, DSCD)
Entity Type:Individual
Prefix:DR
First Name:CHADI
Middle Name:
Last Name:BRIDI
Suffix:
Gender:M
Credentials:DDS, DSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5842 W BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-9170
Mailing Address - Country:US
Mailing Address - Phone:559-740-2734
Mailing Address - Fax:
Practice Address - Street 1:1230 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4436
Practice Address - Country:US
Practice Address - Phone:559-636-2177
Practice Address - Fax:559-636-2145
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics