Healthcare Provider Details

I. General information

NPI: 1336331776
Provider Name (Legal Business Name): DR. ALAN M. OGRADY DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CONANT ST
DANVERS MA
01923-2954
US

IV. Provider business mailing address

36 CONANT ST
DANVERS MA
01923-2954
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-1670
  • Fax: 978-777-1685
Mailing address:
  • Phone: 978-777-1670
  • Fax: 978-777-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12067
License Number StateMA

VIII. Authorized Official

Name: DR. ALAN MICHAEL OGRADY
Title or Position: OWNER
Credential: DDS
Phone: 978-777-1670