Healthcare Provider Details

I. General information

NPI: 1215919246
Provider Name (Legal Business Name): BRIAN R OGLANDER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 WATSON RD SUITE A
SAINT LOUIS MO
63126-1854
US

IV. Provider business mailing address

10000 WATSON RD SUITE A
SAINT LOUIS MO
63126-1854
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-3322
  • Fax: 314-822-0537
Mailing address:
  • Phone: 314-822-3322
  • Fax: 314-822-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number016063
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: