=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568620797
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICK L OGUREK DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/23/2008
-----------------------------------------------------
Last Update Date | 05/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | EAST JERSEY STATE PRISON LOCKBAG R
-----------------------------------------------------
City | RAHWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-396-0492
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 INNERHILL LN
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07747-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-290-8345
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 22DI01532800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------