Provider Demographics
NPI:1609852334
Name:BRUGGEWORTH, SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:BRUGGEWORTH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S 6TH ST
Mailing Address - Street 2:P.O BOX 1298
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-4605
Mailing Address - Country:US
Mailing Address - Phone:856-692-5533
Mailing Address - Fax:856-692-4990
Practice Address - Street 1:120 S 6TH ST
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-4605
Practice Address - Country:US
Practice Address - Phone:856-692-5533
Practice Address - Fax:856-692-4990
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0199331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223674675OtherTAX IDENTIFICATION NUMBER