Provider Demographics
NPI:1508173345
Name:VOGE, RYAN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:VOGE
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 1:2442 NW WESTOVER RD UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3763
Mailing Address - Country:US
Mailing Address - Phone:503-894-8148
Mailing Address - Fax:
Practice Address - Street 1:1221 SW YAMHILL ST STE 310
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2110
Practice Address - Country:US
Practice Address - Phone:503-227-0958
Practice Address - Fax:503-222-4685
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD94631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice