Provider Demographics
NPI:1093608218
Name:VOGEL, BREANNA AILEEN (RDH)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:AILEEN
Last Name:VOGEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 NE 162ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-5642
Mailing Address - Country:US
Mailing Address - Phone:503-257-9836
Mailing Address - Fax:
Practice Address - Street 1:1890 NE 162ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-5642
Practice Address - Country:US
Practice Address - Phone:503-257-9836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8897124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist