Healthcare Provider Details

I. General information

NPI: 1891285318
Provider Name (Legal Business Name): DEBRA BRIDGES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11166 TOTTENHAM RD
CHAPPELL HILL TX
77426-3802
US

IV. Provider business mailing address

PO BOX 84
CHAPPELL HILL TX
77426-0084
US

V. Phone/Fax

Practice location:
  • Phone: 281-808-9094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18074
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: