Healthcare Provider Details

I. General information

NPI: 1720180789
Provider Name (Legal Business Name): ANTON JOHN OGRINC DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6551 WILSON MILLS RD SUITE #103
CLEVELAND OH
44143-3495
US

IV. Provider business mailing address

6551 WILSON MILLS RD SUITE #103
CLEVELAND OH
44143-3495
US

V. Phone/Fax

Practice location:
  • Phone: 440-473-1920
  • Fax: 440-473-0082
Mailing address:
  • Phone: 440-473-1920
  • Fax: 440-473-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: