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NPI Code Detail

MEDICARE: OCG LTD

MEDICARE: OCG LTD
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
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryMN

General Provider Information

NPI Number : 1407970973
Entity Type Code : Organization
Provider Name (Legal Business Name) : OCG LTD
Provider Business Mailing Address
First Line : 14605 GLAZIER AVE
Second Line :
City : APPLE VALLEY
State : MN
Zip : 55124-7545
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2165 WHITE BEAR AVE N
Second Line :
City : MAPLEWOOD
State : MN
Zip : 55109-2707
Country : US
Telephone Number : 651-748-0098
Fax Number :
Authorized Official
Title or Position : DIRECTOR OF OPERATIONS
Name : KARIE T GRADEN
Credential :
Telephone Number : 952-432-1103
Provider Enumeration Date : 03/19/2007
Last Update Date : 07/21/2022

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Directions to “OCG LTD ” Practice Location

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