Healthcare Provider Details

I. General information

NPI: 1447303003
Provider Name (Legal Business Name): MICHAEL BRUGG DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 SAYBROOK RD
MIDDLETOWN CT
06457-4743
US

IV. Provider business mailing address

535 SAYBROOK RD
MIDDLETOWN CT
06457-4743
US

V. Phone/Fax

Practice location:
  • Phone: 860-346-9259
  • Fax:
Mailing address:
  • Phone: 860-346-9259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4166
License Number StateCT

VIII. Authorized Official

Name: DR. MICHAEL L BRUGG
Title or Position: PRESIDENT
Credential: DMD
Phone: 860-346-9259