MEDICARE: ROBERT A BRIDGES DMD

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	1223P0300X	Periodontics	011425	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	838508	OTHER	GA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1558445817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT A BRIDGES DMD

Provider Business Mailing Address
First Line	:	330 MARGIE DR
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-7817
Country	:	US
Telephone Number	:	478-971-4242
Fax Number	:	478-333-6811

Provider Business Practice Location Address
First Line	:	330 MARGIE DR
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-7817
Country	:	US
Telephone Number	:	478-971-4242
Fax Number	:	478-333-6811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	07/08/2007

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