Provider Demographics
NPI:1639204522
Name:BRUEGGEN, HAROLD WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:WAYNE
Last Name:BRUEGGEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14626 BELLAIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-2506
Mailing Address - Country:US
Mailing Address - Phone:281-879-1786
Mailing Address - Fax:281-879-8147
Practice Address - Street 1:14626 BELLAIRE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-2506
Practice Address - Country:US
Practice Address - Phone:281-879-1786
Practice Address - Fax:281-879-8147
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice