Provider Demographics
NPI:1679643787
Name:CRAIG BRIDGEMAN DMD PA
Entity Type:Organization
Organization Name:CRAIG BRIDGEMAN DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:BRIDGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:828-264-7272
Mailing Address - Street 1:2348 HWY 105
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-264-7272
Mailing Address - Fax:828-264-7275
Practice Address - Street 1:2348 HWY 105
Practice Address - Street 2:SUITE 1
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-264-7272
Practice Address - Fax:828-264-7275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty