Provider Demographics
NPI:1841332939
Name:BRUGGEMAN, BRETT CLYDE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:CLYDE
Last Name:BRUGGEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:BRETT
Other - Middle Name:CLYDE
Other - Last Name:BRUGGEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2617 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5202
Mailing Address - Country:US
Mailing Address - Phone:406-452-8180
Mailing Address - Fax:406-452-8195
Practice Address - Street 1:2617 16TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5202
Practice Address - Country:US
Practice Address - Phone:406-452-8180
Practice Address - Fax:406-452-8195
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics