Healthcare Provider Details

I. General information

NPI: 1396358453
Provider Name (Legal Business Name): BRIDGET POWERS DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-1812
US

IV. Provider business mailing address

1000 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-1812
US

V. Phone/Fax

Practice location:
  • Phone: 925-937-1333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number43062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: