Provider Demographics
NPI:1891285318
Name:BRIDGES, DEBRA (DDS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BRIDGES
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:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:CHAPPELL HILL
Mailing Address - State:TX
Mailing Address - Zip Code:77426-0084
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11166 TOTTENHAM RD
Practice Address - Street 2:
Practice Address - City:CHAPPELL HILL
Practice Address - State:TX
Practice Address - Zip Code:77426-3802
Practice Address - Country:US
Practice Address - Phone:281-808-9094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice