Healthcare Provider Details

I. General information

NPI: 1356360465
Provider Name (Legal Business Name): BRIDGEWATER DENTAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 US HIGHWAY 202/206
BRIDGEWATER NJ
08807-1746
US

IV. Provider business mailing address

720 US HIGHWAY 202/206
BRIDGEWATER NJ
08807-1746
US

V. Phone/Fax

Practice location:
  • Phone: 908-707-1133
  • Fax:
Mailing address:
  • Phone: 908-707-1133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01640300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI01796000
License Number StateNJ

VIII. Authorized Official

Name: DR. DAVID M. WEEDON
Title or Position: OWNER
Credential: DDS
Phone: 908-707-1133