MEDICARE: BRIDENT DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467124586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDENT DDS PC

Provider Business Mailing Address
First Line	:	530 S MAIN ST STE 600
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4544
Country	:	US
Telephone Number	:	714-480-3000
Fax Number	:	714-571-6445

Provider Business Practice Location Address
First Line	:	9426 CULLEN BLVD STE B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77051-3321
Country	:	US
Telephone Number	:	713-597-3200
Fax Number	:

Authorized Official
Title or Position	:	CHIEF INFORMATION OFFICER
Name	:	PREET TAKKAR
Credential	:
Telephone Number	:	714-571-3372

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	09/28/2021

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