Organization
BRIDENT DENTAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIBEL ZAMORA (ENROLLMENT COORDINATOR)
(714) 571-3104
Entity
Organization
Contact information
Practice address
815 E BERRY ST STE B, FORT WORTH, TX 76110-4457
(817) 920-5919
(817) 920-5970
Mailing address
530 S MAIN ST STE 600, ORANGE, CA 92868-4544
(714) 480-3000
(714) 571-6445
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
G60850
—
TX
Enumeration date
01/10/2019
Last updated
01/10/2019
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