MEDICARE: BRIDENT DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124759543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDENT DDS PC

Provider Business Mailing Address
First Line	:	530 S MAIN ST
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4525
Country	:	US
Telephone Number	:	714-571-3104
Fax Number	:	714-571-6445

Provider Business Practice Location Address
First Line	:	8145 HIGHWAY 6 S STE 130
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-5740
Country	:	US
Telephone Number	:	281-498-8486
Fax Number	:

Authorized Official
Title or Position	:	ENROLLMENT COORDINATOR
Name	:	MARIBEL ZAMORA
Credential	:
Telephone Number	:	714-571-3104

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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Directions to “BRIDENT DDS PC ” Practice Location

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