Provider Demographics
NPI:1689763930
Name:VOGEL, MARY STALGAITIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:STALGAITIS
Last Name:VOGEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 FORT DUQUESNE BLVD
Mailing Address - Street 2:340 GATEWAY TOWERS
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1121
Mailing Address - Country:US
Mailing Address - Phone:412-261-2183
Mailing Address - Fax:
Practice Address - Street 1:320 FORT DUQUESNE BLVD
Practice Address - Street 2:340 GATEWAY TOWERS
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1121
Practice Address - Country:US
Practice Address - Phone:412-261-2183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018640L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS018640LOtherDENTAL LICENCE