Healthcare Provider Details

I. General information

NPI: 1013321587
Provider Name (Legal Business Name): MATTHEW VOGEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SE 223RD AVE STE 140
GRESHAM OR
97030
US

IV. Provider business mailing address

1201 SE 223RD AVE STE 140
GRESHAM OR
97030-2576
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-8116
  • Fax:
Mailing address:
  • Phone: 503-665-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD009008
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD10891
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: