Provider Demographics
NPI:1356556161
Name:BRIDGHAM, RICHARD L (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:BRIDGHAM
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 1:6 LALLI DR
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-3118
Mailing Address - Country:US
Mailing Address - Phone:914-248-9585
Mailing Address - Fax:
Practice Address - Street 1:293 ROUTE 100
Practice Address - Street 2:MILL POND OFFICES, SUITE 209
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3213
Practice Address - Country:US
Practice Address - Phone:914-277-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046450-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics