Provider Demographics
NPI:1508153198
Name:TINSLEY, BRIDGET ELAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:ELAINE
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRIDGET
Other - Middle Name:ELAINE
Other - Last Name:MACLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:20000 PLUM CANYON RD
Mailing Address - Street 2:UNIT 1627
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2401
Mailing Address - Country:US
Mailing Address - Phone:810-241-8674
Mailing Address - Fax:
Practice Address - Street 1:178 S. VENTURA AVE.
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-4369
Practice Address - Country:US
Practice Address - Phone:805-658-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA618781223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program