| NPI | 1518425636 |
|---|---|
| Doing Business As | BRIDGEPORT DENTAL SMILES LLC |
| Entity Type | Organization |
| Authorized Contact | OSCAR G GONZALEZ Director Of Operations 219-465-8627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2019-03-07 |