Healthcare Provider Details

I. General information

NPI: 1699879882
Provider Name (Legal Business Name): DENNIS B OHARA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 AMPERSAND DRIVE
PLATTSBURGH NY
12901
US

IV. Provider business mailing address

8 AMPERSAND DRIVE
PLATTSBURGH NY
12901
US

V. Phone/Fax

Practice location:
  • Phone: 518-562-1020
  • Fax: 518-562-1022
Mailing address:
  • Phone: 518-562-1020
  • Fax: 518-562-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number0349871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: