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General NPI Number Information
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NPI Number | 1053791061
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Entity Type | Organization
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Legal Business Name | BRIDGE BREAST CENTER
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 4000 JUNIUS ST
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City | DALLAS
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State | TX
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Zip | 75246-1622
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Country | US
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Telephone | 214-821-3820
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Fax | 214-821-0869
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Provider Business Mailing Address
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Address Line | 4000 JUNIUS ST
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City | DALLAS
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State | TX
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Zip | 75246-1622
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Country | US
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Telephone | 214-821-3820
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Fax | 214-821-0869
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. TERRY WILSON-GRAY
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Credential | MPA
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Telephone | 214-821-3820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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