Healthcare Provider Details

I. General information

NPI: 1780759969
Provider Name (Legal Business Name): ROBERT T OGDEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 MAGUIRE RD
WINDERMERE FL
34786-2850
US

IV. Provider business mailing address

PO BOX 2850
WINDERMERE FL
34786-2850
US

V. Phone/Fax

Practice location:
  • Phone: 407-909-3003
  • Fax: 407-909-3004
Mailing address:
  • Phone: 407-909-3003
  • Fax: 407-909-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number50000560876
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: