Provider Demographics
NPI:1932952330
Name:ORTHOBRIDGE, LLC
Entity type:Organization
Organization Name:ORTHOBRIDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-402-1160
Mailing Address - Street 1:1474 FAIRMONT AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4399
Mailing Address - Country:US
Mailing Address - Phone:404-402-1160
Mailing Address - Fax:
Practice Address - Street 1:3180 N POINT PKWY STE 521
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4569
Practice Address - Country:US
Practice Address - Phone:404-402-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty