| NPI | 1306460001 |
|---|---|
| Doing Business As | BRIDGELAKE FAMILY DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | MARK TINNEY Owner/Dentist 985-590-5175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2020-05-29 |
| Last Update Date | 2020-05-29 |