Individual
CHARLES LEE BRIDGEFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
117 NORTH WASHINGTON STREET, GRAND FORKS, ND 58203
(701) 746-0485
(701) 746-3201
Mailing address
117 NORTH WASHINGTON STREET, GRAND FORKS, ND 58203
(701) 746-0485
(701) 746-3201
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1631
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41252
—
ND
01
—
672283
UNITED CONCORDIA MILITARY
—
01
—
901631
DENTAL SERVICE CORP INSUR
—
Enumeration date
11/01/2006
Last updated
07/09/2007
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