Provider Demographics
NPI:1730221367
Name:VOGEL, JEREMY TODD (DDS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:TODD
Last Name:VOGEL
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 1:156 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-1118
Mailing Address - Country:US
Mailing Address - Phone:715-926-4459
Mailing Address - Fax:715-926-4625
Practice Address - Street 1:156 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONDOVI
Practice Address - State:WI
Practice Address - Zip Code:54755-1118
Practice Address - Country:US
Practice Address - Phone:715-926-4459
Practice Address - Fax:715-926-4625
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI58961223G0001X
ND19681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice