Provider Demographics
NPI:1255428645
Name:BRIDGMAN, THOMAS RICHARD (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:BRIDGMAN
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 1:1333 HARBOR AVE SW APT 301
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-1781
Mailing Address - Country:US
Mailing Address - Phone:206-406-2124
Mailing Address - Fax:
Practice Address - Street 1:18010 8TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98148-1908
Practice Address - Country:US
Practice Address - Phone:206-812-2460
Practice Address - Fax:206-812-2455
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006153122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentistGroup - Multi-Specialty