Provider Demographics
NPI:1093788614
Name:VOGT, DANIEL JAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAY
Last Name:VOGT
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 1:95 STRATFORD VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-5059
Mailing Address - Country:US
Mailing Address - Phone:843-548-0695
Mailing Address - Fax:
Practice Address - Street 1:16 WILLIAM POPE DR
Practice Address - Street 2:SUITE #104
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7502
Practice Address - Country:US
Practice Address - Phone:843-705-7675
Practice Address - Fax:843-987-3164
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4394122300000X
PADS016290L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist