Organization
ARIZONA HAVASU BDM PAK LLC
Active
Other names
Bridge Lake Dental
Organization subpart
No
Provider details
NPI number
Authorized official
ROLAND PISCHINGER (INSURANCE DEPARTMENT MANAGER)
(702) 522-2028
Entity
Organization
Contact information
Practice address
1799 NORTH KIOWA BLVD, UNIT 109, LAKE HAVASU, AZ 86403
(928) 399-7711
(928) 399-7710
Mailing address
2101 S JONES BLVD STE 140, LAS VEGAS, NV 89146-3133
(702) 522-2025
(702) 990-8856
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
10/13/2014
Last updated
05/31/2018
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