Organization
TRACE BRIDGES FAMILY DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE I. TRACE BRIDGES III DDS (OWNER)
(580) 536-7507
Entity
Organization
Contact information
Practice address
2928 NW CACHE RD, LAWTON, OK 73505-3827
(580) 355-8300
(580) 355-8798
Mailing address
2928 NW CACHE RD, LAWTON, OK 73505-3827
(580) 355-8300
(580) 355-8798
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5215
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
860044
UNITED CONCORDIA
OK
Enumeration date
10/13/2006
Last updated
08/22/2020
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