1295843654 NPI number — SAMUEL JAMES OGDEN DMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295843654 NPI number — SAMUEL JAMES OGDEN DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMUEL JAMES OGDEN DMD
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:
6
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:
1295843654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 167
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MER ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71261-0167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-647-3960
Provider Business Mailing Address Fax Number:
318-647-3960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 SOUTH 20TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MER ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71261-0167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-647-3960
Provider Business Practice Location Address Fax Number:
318-647-3960
Provider Enumeration Date:
08/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OGDEN
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PRESIDENT CORPORATION
Authorized Official Telephone Number:
318-647-3960

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  1401 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1814016 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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