Provider Demographics
NPI:1952460875
Name:VOGL, WALT KEVIN (DDS)
Entity Type:Individual
Prefix:
First Name:WALT
Middle Name:KEVIN
Last Name:VOGL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OAKWOOD PARK PLZ
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1884
Mailing Address - Country:US
Mailing Address - Phone:303-663-9600
Mailing Address - Fax:303-663-9627
Practice Address - Street 1:2 OAKWOOD PARK PLZ
Practice Address - Street 2:SUITE 206
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1884
Practice Address - Country:US
Practice Address - Phone:303-663-9600
Practice Address - Fax:303-663-9627
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551481223G0001X
CO8793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice