Provider Demographics
NPI:1578613279
Name:COULTER, BRIDGETTE E (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGETTE
Middle Name:E
Last Name:COULTER
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 1:416 W WALNUT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1836
Mailing Address - Country:US
Mailing Address - Phone:859-236-6181
Mailing Address - Fax:859-236-5435
Practice Address - Street 1:416 W WALNUT ST
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1836
Practice Address - Country:US
Practice Address - Phone:859-236-6181
Practice Address - Fax:859-236-5435
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice