Healthcare Provider Details

I. General information

NPI: 1912031121
Provider Name (Legal Business Name): JOHN E OGRO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SANTA MARIA WAY
ORINDA CA
94563
US

IV. Provider business mailing address

5 SANTA MARIA WAY
ORINDA CA
94563
US

V. Phone/Fax

Practice location:
  • Phone: 925-254-2133
  • Fax: 925-254-3034
Mailing address:
  • Phone: 925-254-2133
  • Fax: 925-254-3034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number34641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: