Individual
DR. VERN BARRY BRUGGEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
333 SO WOODRUFF AVE, IDAHO FALLS, ID 83401
(208) 524-2036
(208) 523-9004
Mailing address
333 SO WOODRUFF AVE, IDAHO FALLS, ID 83401
(208) 524-2036
(208) 523-9004
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1471
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001596200
—
ID
Enumeration date
02/14/2007
Last updated
06/11/2008
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