MEDICARE: DR. CANDICE G. MCMULLAN-VOGEL DDS, FAGD

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	1223G0001X	General Practice Dentistry	DT2015	HI

General Provider Information

NPI Number	:	1992782262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CANDICE G. MCMULLAN-VOGEL DDS, FAGD

Provider Business Mailing Address
First Line	:	1594 LAUKAHI ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96821-1432
Country	:	US
Telephone Number	:	808-373-4321
Fax Number	:	808-373-5198

Provider Business Practice Location Address
First Line	:	1594 LAUKAHI ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96821-1432
Country	:	US
Telephone Number	:	808-373-4321
Fax Number	:	808-373-5198

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	07/13/2007

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