Provider Demographics
NPI:1558584755
Name:BRIDGEVIEW DENTAL S.C.
Entity Type:Organization
Organization Name:BRIDGEVIEW DENTAL S.C.
Other - Org Name:JOHN F. RICHARDSON, DDS SC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-235-6040
Mailing Address - Street 1:212 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-5884
Mailing Address - Country:US
Mailing Address - Phone:920-235-6040
Mailing Address - Fax:920-235-6029
Practice Address - Street 1:212 OHIO ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-5884
Practice Address - Country:US
Practice Address - Phone:920-235-6040
Practice Address - Fax:920-235-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33473900Medicare ID - Type Unspecified