Provider Demographics
NPI:1013003979
Name:VOGELSANG, BRIAN LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:LEE
Last Name:VOGELSANG
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 1:60 SOUTH CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOGADORE
Mailing Address - State:OH
Mailing Address - Zip Code:44260-1442
Mailing Address - Country:US
Mailing Address - Phone:330-628-2424
Mailing Address - Fax:330-628-3533
Practice Address - Street 1:60 SOUTH CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:MOGADORE
Practice Address - State:OH
Practice Address - Zip Code:44260-1442
Practice Address - Country:US
Practice Address - Phone:330-628-2424
Practice Address - Fax:330-628-3533
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist