Provider Demographics
NPI:1972760429
Name:VIDRINE, BRIDGETTE MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIDGETTE
Middle Name:MICHELLE
Last Name:VIDRINE
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 1:506 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5220
Mailing Address - Country:US
Mailing Address - Phone:337-942-3441
Mailing Address - Fax:337-942-3461
Practice Address - Street 1:506 N COURT ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5220
Practice Address - Country:US
Practice Address - Phone:337-942-3441
Practice Address - Fax:337-942-3461
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA58851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1858854Medicaid