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General NPI Number Information
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NPI Number | 1700648540
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Entity Type | Individual
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Provider Name | BRIDGETT ETHERIDGE-MAY
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Gender | Female
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Dates
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Enumeration Date | 01/26/2024
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Last Update Date | 01/26/2024
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Provider Practice Location Address
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Address Line | 2901 LIBERTY HEIGHTS AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-7893
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Country | US
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Telephone | 410-462-7451
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Fax |
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Provider Business Mailing Address
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Address Line | 416 CRYSTAL DOWNS CT
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4195
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Country | US
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Telephone | 443-929-3939
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 4484
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License Number State | MD
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