Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 30016997 | OH |
NPI | 1013003979 |
---|---|
Provider Name | Dr. Brian Lee Vogelsang |
First Address | Mogadore, OH 44260-1442 |
Second Address | Mogadore, OH 44260-1442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |