Healthcare Provider Details

I. General information

NPI: 1235331810
Provider Name (Legal Business Name): JOHN P OGRADY JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6772 FOREST HILL BLVD
GREENACRES FL
33413
US

IV. Provider business mailing address

6772 FOREST HILL BLVD
GREENACRES FL
33413
US

V. Phone/Fax

Practice location:
  • Phone: 561-966-3531
  • Fax: 561-966-6388
Mailing address:
  • Phone: 561-966-3531
  • Fax: 561-966-6388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN9687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: