Provider Demographics
NPI:1447413729
Name:BRIDGES, LAURA COYLE (DMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:COYLE
Last Name:BRIDGES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 LITHIA PINECREST ROAD
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596
Mailing Address - Country:US
Mailing Address - Phone:813-654-3399
Mailing Address - Fax:813-436-5543
Practice Address - Street 1:3646 LITHIA PINECREST ROAD
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33596
Practice Address - Country:US
Practice Address - Phone:813-654-3399
Practice Address - Fax:813-436-5543
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-07
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN184471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice