Provider Demographics
NPI:1609803584
Name:BAINBRIDGE, JEAN EVELYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:EVELYN
Last Name:BAINBRIDGE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 S BUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-4313
Mailing Address - Country:US
Mailing Address - Phone:214-388-4453
Mailing Address - Fax:214-388-9555
Practice Address - Street 1:3914 S BUCKNER BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-4313
Practice Address - Country:US
Practice Address - Phone:214-388-4453
Practice Address - Fax:214-388-9555
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice