Provider Demographics
NPI:1629278668
Name:FOGEL, DANIEL Y (DMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:Y
Last Name:FOGEL
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 1:1 HILLCREST CTR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3740
Mailing Address - Country:US
Mailing Address - Phone:845-517-5700
Mailing Address - Fax:
Practice Address - Street 1:1 HILLCREST CTR
Practice Address - Street 2:SUITE 107
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3740
Practice Address - Country:US
Practice Address - Phone:845-517-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0531051223G0001X
NJ22DI023495001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice