Provider Demographics
NPI:1427227180
Name:VOGEL, SUSAN RUTH (RDH)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RUTH
Last Name:VOGEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:RUTH
Other - Last Name:PAGNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1220 OAK PARK DR STE 6
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7348
Mailing Address - Country:US
Mailing Address - Phone:970-227-5642
Mailing Address - Fax:
Practice Address - Street 1:1220 OAK PARK DR STE 6
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7348
Practice Address - Country:US
Practice Address - Phone:970-227-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO902996124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94978051Medicaid