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General NPI Number Information
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NPI Number | 1184031924
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Entity Type | Individual
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Provider Name | MELISSA BLAIR BRIDY BRIM DMD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 1333 BROADWAY STE 800
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City | OAKLAND
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State | CA
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Zip | 94612-1924
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Country | US
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Telephone | 877-355-8273
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Fax |
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Provider Business Mailing Address
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Address Line | 1333 BROADWAY STE 800
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City | OAKLAND
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State | CA
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Zip | 94612-1924
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Country | US
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Telephone | 877-335-8273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9922
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9572
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN20606
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License Number State | FL
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