Provider Demographics
NPI:1720124407
Name:VOSE, DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:VOSE
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 1:220 E MAIN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3574
Mailing Address - Country:US
Mailing Address - Phone:507-387-2255
Mailing Address - Fax:507-387-2255
Practice Address - Street 1:220 E MAIN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3574
Practice Address - Country:US
Practice Address - Phone:507-387-2255
Practice Address - Fax:507-387-2255
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice