Provider Demographics
NPI:1174041990
Name:OGBURN, DORIS D (RDH)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:D
Last Name:OGBURN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4727 ST ANTOINE STREET
Mailing Address - Street 2:SUIT 408
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-833-7309
Mailing Address - Fax:313-833-5022
Practice Address - Street 1:4727 ST ANTOINE STREET
Practice Address - Street 2:SUITE 408
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-833-7309
Practice Address - Fax:313-833-5022
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL493262124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist