Provider Demographics
NPI:1932489705
Name:CALLAWAY, BRIDGET O'BRIEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:O'BRIEN
Last Name:CALLAWAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:O'BRIEN
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:450 TURNER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-5211
Mailing Address - Country:US
Mailing Address - Phone:850-452-5600
Mailing Address - Fax:
Practice Address - Street 1:450 TURNER ST
Practice Address - Street 2:SUITE B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-5211
Practice Address - Country:US
Practice Address - Phone:850-452-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3609-11122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist