Provider Demographics
NPI:1922144542
Name:BRIDGWATER, DAVID F (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:BRIDGWATER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 W PARK ROW DR
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3170
Mailing Address - Country:US
Mailing Address - Phone:817-277-1188
Mailing Address - Fax:817-795-1377
Practice Address - Street 1:3310 W PARK ROW DR
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-3170
Practice Address - Country:US
Practice Address - Phone:817-277-1188
Practice Address - Fax:817-795-1377
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist