Provider Demographics
NPI:1154414480
Name:VOGT, ADRIAN MICHAEL (DDS, MSD)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:MICHAEL
Last Name:VOGT
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 N SAN MATEO DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2624
Mailing Address - Country:US
Mailing Address - Phone:650-343-3603
Mailing Address - Fax:
Practice Address - Street 1:256 N SAN MATEO DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2624
Practice Address - Country:US
Practice Address - Phone:650-343-3603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA405081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics