| NPI | 1821655697 |
|---|---|
| Doing Business As | BRIDGE STREET DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | HILLARY THULL Credentialing 217-540-6078 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2023-01-17 |