MEDICARE: DR. DANIEL JAY VOGT DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4394	SC
2	122300000X	Dentist	DS016290L	PA

General Provider Information

NPI Number	:	1093788614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL JAY VOGT DMD

Provider Business Mailing Address
First Line	:	95 STRATFORD VILLAGE WAY
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29909-5059
Country	:	US
Telephone Number	:	843-548-0695
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 WILLIAM POPE DR
Second Line	:	SUITE #104
City	:	BLUFFTON
State	:	SC
Zip	:	29909-7502
Country	:	US
Telephone Number	:	843-705-7675
Fax Number	:	843-987-3164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	09/24/2007

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