Provider Demographics
NPI:1700648540
Name:ETHERIDGE-MAY, BRIDGETT
Entity Type:Individual
Prefix:
First Name:BRIDGETT
Middle Name:
Last Name:ETHERIDGE-MAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 CRYSTAL DOWNS CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4195
Mailing Address - Country:US
Mailing Address - Phone:443-929-3939
Mailing Address - Fax:
Practice Address - Street 1:2901 LIBERTY HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-7893
Practice Address - Country:US
Practice Address - Phone:410-462-7451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4484124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist