Provider Demographics
NPI:1528067188
Name:BRIGATI, JESSICA H (DDS)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:H
Last Name:BRIGATI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 OVERTON RIDGE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1940
Mailing Address - Country:US
Mailing Address - Phone:817-370-0065
Mailing Address - Fax:817-370-2699
Practice Address - Street 1:4900 OVERTON RIDGE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1940
Practice Address - Country:US
Practice Address - Phone:817-370-0065
Practice Address - Fax:817-370-2699
Is Sole Proprietor?:No
Enumeration Date:2005-07-17
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD20889OtherBLUE CROSS BLUE SHIELD