Provider Demographics
NPI:1336279256
Name:VOGEL, MARCUS L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:L
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 1:3000 NORTH 14TH STREET
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0698
Mailing Address - Country:US
Mailing Address - Phone:701-255-0469
Mailing Address - Fax:701-223-3677
Practice Address - Street 1:3000 NORTH 14TH STREET
Practice Address - Street 2:SUITE 2D
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0698
Practice Address - Country:US
Practice Address - Phone:701-255-0469
Practice Address - Fax:701-223-3677
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND16421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40861Medicaid
ND901642OtherDENTAL SOURCE CORP