Provider Demographics
NPI:1750667812
Name:VOGEL, EVAN JAMES (DDS,,MS)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:JAMES
Last Name:VOGEL
Suffix:
Gender:M
Credentials:DDS,,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39263 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1519
Mailing Address - Country:US
Mailing Address - Phone:510-793-5513
Mailing Address - Fax:510-793-5213
Practice Address - Street 1:39263 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1519
Practice Address - Country:US
Practice Address - Phone:510-793-5513
Practice Address - Fax:510-793-5213
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics