Healthcare Provider Details

I. General information

NPI: 1528145976
Provider Name (Legal Business Name): OGDEN FAMILY DENTAL PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 W MULBERRY
OGDEN IA
50212-0813
US

IV. Provider business mailing address

237 W MULBERRY
OGDEN IA
50212-0813
US

V. Phone/Fax

Practice location:
  • Phone: 515-275-2250
  • Fax: 515-275-2816
Mailing address:
  • Phone: 515-275-2250
  • Fax: 515-275-2816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDR MARK W PLATT 6772
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDR JEFF GRAGG 08240
License Number StateIA

VIII. Authorized Official

Name: DR. MARK W PLATT
Title or Position: DR CO OWNER
Credential: DDS
Phone: 515-275-2250