1205252301 NPI number — ALPHA DENTAL GROUP, INC

Table of content: DR. PATRICK DAVID OGILVIE MD (NPI 1821099003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205252301 NPI number — ALPHA DENTAL GROUP, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA DENTAL GROUP, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205252301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4999 W 8TH AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33012-3409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-238-7406
Provider Business Mailing Address Fax Number:
786-238-7429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4999 W AVE
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-238-7406
Provider Business Practice Location Address Fax Number:
786-238-7429
Provider Enumeration Date:
03/13/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VAZQUEZ
Authorized Official First Name:
YAREMI
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANEGER
Authorized Official Telephone Number:
786-238-7406

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)