Provider Demographics
NPI:1669864476
Name:BRIDGET MACKEY DDS, LLC
Entity Type:Organization
Organization Name:BRIDGET MACKEY DDS, LLC
Other - Org Name:SUDBURY DENTAL ARTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:414-732-8043
Mailing Address - Street 1:144 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1156
Mailing Address - Country:US
Mailing Address - Phone:978-369-2500
Mailing Address - Fax:
Practice Address - Street 1:144 NORTH RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-1156
Practice Address - Country:US
Practice Address - Phone:978-369-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18556891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty