Healthcare Provider Details

I. General information

NPI: 1831349596
Provider Name (Legal Business Name): YUMI OGATA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 LONGWOOD AVE UNIT 3
BROOKLINE MA
02446-5240
US

IV. Provider business mailing address

36 LONGWOOD AVE
BROOKLINE MA
02446-5240
US

V. Phone/Fax

Practice location:
  • Phone: 718-474-3331
  • Fax:
Mailing address:
  • Phone: 781-474-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN1857013
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: