IndividualActive
Rod Bridge, D.D.S.PERIODONTIST
NPI 1174741227 · Periodontics · Provo, UT
Provider details
- NPI number
- 1174741227
- Entity type
- Individual
- Primary specialty
- PeriodonticsDental Providers
- Credential
- D.D.S.PERIODONTIST
- Sex
- Male
- Sole proprietor
- Yes
- License
- 22150 (UT)
Specialties & taxonomies
Dental Providers
Practice location
745 N 500 W
Suite 102
Provo, UT 84601-1472
Phone: (801) 374-8002
Fax: (801) 371-0393
Approximate (ZIP-level) locationGet directions
Mailing address
745 N 500 W
Provo, UT 84601-1472
Registry dates
- Enumerated
- 2007-04-23
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.