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General NPI Number Information
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NPI Number | 1619010477
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Entity Type | Individual
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Provider Name | VERN BARRY BRUGGEMAN DDS
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Gender | Male
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 06/11/2008
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Provider Practice Location Address
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Address Line | 333 SO WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401
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Country | US
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Telephone | 208-524-2036
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Fax | 208-523-9004
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Provider Business Mailing Address
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Address Line | 333 SO WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401
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Country | US
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Telephone | 208-524-2036
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Fax | 208-523-9004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D1471
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License Number State | ID
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