Healthcare Provider Details

I. General information

NPI: 1194731646
Provider Name (Legal Business Name): ORRETT EVERARD OGLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 BROADWAY DENTAL: 2C-320
BROOKLYN NY
11206-5317
US

IV. Provider business mailing address

760 BROADWAY DENTAL: 2C-320
BROOKLYN NY
11206-5317
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-8313
  • Fax: 718-630-3244
Mailing address:
  • Phone: 718-963-8313
  • Fax: 718-630-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number031237
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: