Healthcare Provider Details

I. General information

NPI: 1417026196
Provider Name (Legal Business Name): DORA MARIA OGANDO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 W 190TH ST SUITE 2
NEW YORK NY
10040-3566
US

IV. Provider business mailing address

107 WEST 4TH STREET
MOUNT VERNON NY
10550
US

V. Phone/Fax

Practice location:
  • Phone: 212-927-0090
  • Fax: 212-927-8543
Mailing address:
  • Phone: 914-699-7200
  • Fax: 914-699-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number048533-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number048533
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: