Provider Demographics
NPI:1235264300
Name:OG FAMILY & GENERAL DENTISTRY
Entity Type:Organization
Organization Name:OG FAMILY & GENERAL DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIGRO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:419-538-7400
Mailing Address - Street 1:112 DR. THATYE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GLANDORF
Mailing Address - State:OH
Mailing Address - Zip Code:45848-0040
Mailing Address - Country:US
Mailing Address - Phone:419-538-7400
Mailing Address - Fax:419-538-7401
Practice Address - Street 1:112 DR. THATYE DRIVE
Practice Address - Street 2:
Practice Address - City:GLANDORF
Practice Address - State:OH
Practice Address - Zip Code:45848-0040
Practice Address - Country:US
Practice Address - Phone:419-538-7400
Practice Address - Fax:419-538-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH150271223G0001X
PA206001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty