Healthcare Provider Details

I. General information

NPI: 1477624203
Provider Name (Legal Business Name): TERRY T OGURA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 W DUARTE RD SUITE # 1
ARCADIA CA
91007-7331
US

IV. Provider business mailing address

550 W DUARTE RD STE 1
ARCADIA CA
91007-7361
US

V. Phone/Fax

Practice location:
  • Phone: 626-447-8678
  • Fax: 626-447-2553
Mailing address:
  • Phone: 626-447-8678
  • Fax: 626-447-2553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: