Provider Demographics
NPI:1801107222
Name:LERVICK, BRIDGET JEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:JEAN
Last Name:LERVICK
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 1:5201 EDEN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436
Mailing Address - Country:US
Mailing Address - Phone:952-746-0225
Mailing Address - Fax:952-746-0227
Practice Address - Street 1:5201 EDEN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436
Practice Address - Country:US
Practice Address - Phone:952-746-0225
Practice Address - Fax:952-746-0227
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12810122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist