Healthcare Provider Details

I. General information

NPI: 1720767718
Provider Name (Legal Business Name): ABAGAEL MARIE BRIDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36855 AMERICAN WAY STE C
AVON OH
44011-4059
US

IV. Provider business mailing address

36855 AMERICAN WAY STE C
AVON OH
44011-4059
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-0149
  • Fax:
Mailing address:
  • Phone: 440-934-0149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30.027593
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: