Healthcare Provider Details

I. General information

NPI: 1316000581
Provider Name (Legal Business Name): BENJAMIN FREDRICK OGLETREE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BENJAMIN FREDRICK OGLETREE DDS

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 N 5TH STR #1
COLUMBUS MS
39705-2005
US

IV. Provider business mailing address

2401 5TH ST N # 1
COLUMBUS MS
39705-2005
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1825
  • Fax: 662-328-1825
Mailing address:
  • Phone: 662-328-1825
  • Fax: 662-328-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1676-75
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: