Organization
BRADLEY VERGIEN DDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY VERGIEN (OWNER)
(505) 879-9191
Entity
Organization
Contact information
Practice address
1421 US 491, GALLUP, NM 87301
(505) 863-8000
Mailing address
1600 MILDA ST, GALLUP, NM 87301-6117
(505) 879-9191
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD1926
NM
Other
Enumeration date
05/05/2010
Last updated
05/05/2010
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