Provider Demographics
NPI:1619956612
Name:KOAGEL, SUSAN OAKES (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:OAKES
Last Name:KOAGEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:MICHELLE
Other - Last Name:OAKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:DEPT OF THE ARMY, DENTAL ACTIVITY STOP B
Mailing Address - Street 2:2817 REILLY RD, MCDS-NA-B
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-396-5610
Mailing Address - Fax:910-396-7017
Practice Address - Street 1:DEPT OF THE ARMY, DENTAL ACTIVITY STOP B
Practice Address - Street 2:2817 REILLY RD, MCDS-NA-B
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-396-5610
Practice Address - Fax:910-396-7017
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000096111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BO8525872OtherFEDERAL DEA