Provider Demographics
NPI:1457384901
Name:BRIDGEWATER, MARTHA PINTO (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:PINTO
Last Name:BRIDGEWATER
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 1:121 S MADISON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-3031
Mailing Address - Country:US
Mailing Address - Phone:303-320-3601
Mailing Address - Fax:303-399-5598
Practice Address - Street 1:121 S MADISON ST
Practice Address - Street 2:SUITE C
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-3031
Practice Address - Country:US
Practice Address - Phone:303-320-3601
Practice Address - Fax:303-399-5598
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71501223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO149580OtherCIGNA DHMO
CO11878OtherPACIFICARE
CO36267OtherUNITED DENTAL CARE
CO972231OtherUNITED CONCORDIA
CO5861329OtherAETNA