Bradley Vergien Dds, LLC

NPI #1417275165 in Gallup, New Mexico

Provider Information

NPI Number: 1417275165
Entity Type: Organization
Organization Name: Bradley Vergien Dds, LLC
Primary Specialty: Dentist
Enumeration Date: May 5, 2010
Last Updated: May 5, 2010

Practice Location

Address: 1421 US 491
City: Gallup
State: New Mexico
ZIP Code: 87301
Phone: (505) 863-8000

Authorized Official

Name: DR. BRADLEY VERGIEN
Title: OWNER
Phone: (505) 879-9191

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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