Provider Demographics
NPI:1548248743
Name:BRIDGES, GEORGE IMBODEN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:IMBODEN
Last Name:BRIDGES
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 NW CACHE RD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3634
Mailing Address - Country:US
Mailing Address - Phone:580-581-9500
Mailing Address - Fax:580-581-0984
Practice Address - Street 1:4006 NW CACHE RD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3634
Practice Address - Country:US
Practice Address - Phone:580-581-9500
Practice Address - Fax:580-581-0984
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist