Provider Demographics
NPI:1801086475
Name:VOGLER, GERALD LINUS (DDS)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:LINUS
Last Name:VOGLER
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:PO BOX 472
Mailing Address - Street 2:37 HICKORY DRIVE
Mailing Address - City:RANDOM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53075-0472
Mailing Address - Country:US
Mailing Address - Phone:920-994-4367
Mailing Address - Fax:920-994-8800
Practice Address - Street 1:37 HICKORY DRIVE
Practice Address - Street 2:
Practice Address - City:RANDOM LAKE
Practice Address - State:WI
Practice Address - Zip Code:53075-0472
Practice Address - Country:US
Practice Address - Phone:920-994-4367
Practice Address - Fax:920-994-8800
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
5290680OtherDEA