Healthcare Provider Details

I. General information

NPI: 1891901724
Provider Name (Legal Business Name): ROBERT OGDEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BROWN ST. SUITE 102
GRANITE QUARRY NC
28072
US

IV. Provider business mailing address

17 NORTH RD
SALISBURY NC
28144-6907
US

V. Phone/Fax

Practice location:
  • Phone: 704-279-2121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5674
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: