Active NPI
Charles Lee Bridgeford, DDS
- Dentist
- Grand Forks, ND
National Provider Identifier
1245318625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1631
- Practice address
- 117 North Washington Street
Grand Forks, ND 58203 - Phone
- (701) 746-0485
- Fax
- (701) 746-3201
- NPI assigned
- Nov 1, 2006
- Last updated
- Jul 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1631 | ND | Primary |
Addresses
Primary practice location
117 North Washington Street
Grand Forks, ND 58203
Mailing address
117 North Washington Street
Grand Forks, ND 58203
Phone (701) 746-0485
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 901631 | Other | DENTAL SERVICE CORP INSUR | |
| 672283 | Other | UNITED CONCORDIA MILITARY | |
| 41252 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1245318625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "117 NORTH WASHINGTON STREET",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "58203",
"telephone_number": "701-746-0485",
"fax_number": "701-746-3201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "117 NORTH WASHINGTON STREET",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "58203",
"telephone_number": "701-746-0485",
"fax_number": "701-746-3201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRIDGEFORD",
"first_name": "CHARLES",
"middle_name": "LEE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ND",
"license": "1631",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL SERVICE CORP INSUR",
"identifier": "901631",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA MILITARY",
"identifier": "672283",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "41252",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.