Individual
DR. BRADLEY VERGIEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1421 US 491, GALLUP, NM 87301
(505) 863-8000
(505) 863-8700
Mailing address
1600 MILDA ST, GALLUP, NM 87301-6117
(505) 879-9191
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
145124-9921
UT
122300000X
Dentist
759
AK
122300000X
Dentist
D3565
AZ
122300000X
Dentist
Primary
DD1926
NM
Other
Enumeration date
12/27/2006
Last updated
05/20/2010
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