Healthcare Provider Details

I. General information

NPI: 1295843654
Provider Name (Legal Business Name): SAMUEL JAMES OGDEN DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SOUTH 20TH STREET
MER ROUGE LA
71261-0167
US

IV. Provider business mailing address

PO BOX 167
MER ROUGE LA
71261-0167
US

V. Phone/Fax

Practice location:
  • Phone: 318-647-3960
  • Fax: 318-647-3960
Mailing address:
  • Phone: 318-647-3960
  • Fax: 318-647-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1401
License Number StateLA

VIII. Authorized Official

Name: SAMUEL JAMES OGDEN SR.
Title or Position: PRESIDENT CORPORATION
Credential: DMD
Phone: 318-647-3960