Bradley Vergien, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DD1926 Issued in NM

Practice address

1421 US 491
Gallup, NM 87301

Phone

(505) 863-8000

Fax

(505) 863-8700

NPI assigned

Dec 27, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bradley Vergien DDS, LLC

  • Dentist
  • Gallup, NM
  • NPI 1417275165
  NPD (past) Authorized official
• Gallup Dental Group

  • Dentist
  • Gallup, NM
  • NPI 1235457607
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274313600000",
    "number": "1790841765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 MILDA ST",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873016117",
            "telephone_number": "505-879-9191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 US 491",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "87301",
            "telephone_number": "505-863-8000",
            "fax_number": "505-863-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERGIEN",
        "first_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-27",
        "last_updated": "2010-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD1926",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D3565",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "145124-9921",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "759",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joann Vazquez
• Maria G Velazquez, RN
• Velez Case Management
• Olga Velez, RN
• Gabriella D Ventresca, RN
• Ainsley Verkaik, OD
• Nicole Lea Vest
• Jessica Vickers
• Marlene Vickery, RN
• Grace Victor, PHARMD

• Dentist in Gallup, NM
• Providers in Gallup, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.