Provider Demographics
NPI:1205974813
Name:MCANTHONY, BRIDGET DURELL (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:DURELL
Last Name:MCANTHONY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 162074
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76161-2074
Mailing Address - Country:US
Mailing Address - Phone:817-788-9500
Mailing Address - Fax:817-520-1556
Practice Address - Street 1:5332 N TARRANT PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-6293
Practice Address - Country:US
Practice Address - Phone:817-788-9500
Practice Address - Fax:817-520-1556
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry