Healthcare Provider Details

I. General information

NPI: 1194752782
Provider Name (Legal Business Name): LINDA D MCBRIDE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 COHANSEY ST
BRIDGETON NJ
08302-1918
US

IV. Provider business mailing address

6103 QUAIL DR
PORT NORRIS NJ
08349-3535
US

V. Phone/Fax

Practice location:
  • Phone: 856-451-4700
  • Fax: 856-451-0029
Mailing address:
  • Phone: 856-785-7030
  • Fax: 856-785-7030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI01773203
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: