Healthcare Provider Details

I. General information

NPI: 1508124363
Provider Name (Legal Business Name): MAREK JAROSLAW OGLEDZKI MD, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 10/02/2022
Certification Date: 10/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORRIS ST STE 309
CHARLESTON WV
25301-1853
US

IV. Provider business mailing address

415 MORRIS ST STE 309
CHARLESTON WV
25301-1853
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-3290
  • Fax:
Mailing address:
  • Phone: 304-388-3290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN20042
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number31800
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901600263
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN20042
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberTRN23463
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4301116139
License Number StateMI
# 7
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4592
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: