Provider Demographics
NPI:1962544510
Name:FOGEL, BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:
Last Name:FOGEL
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 1:27950 ROBLE BLANCO DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-2464
Mailing Address - Country:US
Mailing Address - Phone:650-948-4815
Mailing Address - Fax:
Practice Address - Street 1:2155 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2333
Practice Address - Country:US
Practice Address - Phone:415-929-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA213661223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics