Healthcare Provider Details

I. General information

NPI: 1477666337
Provider Name (Legal Business Name): ALAN MICHAEL OGRADY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CONANT STREET
DANVERS MA
01923
US

IV. Provider business mailing address

36 CONANT STREET
DANVERS MA
01923
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:
Title or Position:
Credential:
Phone: