Provider Demographics
NPI:1265581193
Name:HENNESSY, BRIDGET K (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:K
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 HIGHLAND COVE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-2158
Mailing Address - Country:US
Mailing Address - Phone:205-873-5454
Mailing Address - Fax:
Practice Address - Street 1:28425 STATE HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-1657
Practice Address - Country:US
Practice Address - Phone:205-625-4384
Practice Address - Fax:205-625-4386
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice