Life Bridge Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

LIFE BRIDGE DENTAL LLC

Practice address

11564 Old Georgetown Road
North Bethesda, MD 20852

Phone

(212) 686-3686

Fax

(615) 468-0325

NPI assigned

May 5, 2022

Last updated

May 5, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Kenneth Neilq Sullivan

Title

Director, RCM

Phone

(212) 686-3686

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1538805346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 CITY BLVD STE 203",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372092559",
            "telephone_number": "212-686-3686",
            "fax_number": "615-468-0325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11564 OLD GEORGETOWN ROAD",
            "city": "NORTH BETHESDA",
            "state": "MD",
            "postal_code": "20852",
            "telephone_number": "212-686-3686",
            "fax_number": "615-468-0325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE BRIDGE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-05",
        "last_updated": "2022-05-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "NEILQ",
        "authorized_official_title_or_position": "DIRECTOR, RCM",
        "authorized_official_telephone_number": "212-686-3686",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in North Bethesda, MD
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.