Individual
DR. ROD J. BRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.PERIODONTIST
Contact information
Practice address
745 N 500 W, SUITE 102, PROVO, UT 84601-1472
(801) 374-8002
(801) 371-0393
Mailing address
745 N 500 W, SUITE 102, PROVO, UT 84601-1472
(801) 374-8002
(801) 371-0393
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
22150
UT
Other
Enumeration date
04/23/2007
Last updated
07/08/2007
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