Provider Demographics
NPI:1316000581
Name:OGLETREE, BENJAMIN FREDRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:FREDRICK
Last Name:OGLETREE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BENJAMIN
Other - Middle Name:FREDRICK
Other - Last Name:OGLETREE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2401 5TH ST N # 1
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2005
Mailing Address - Country:US
Mailing Address - Phone:662-328-1825
Mailing Address - Fax:662-328-1825
Practice Address - Street 1:2401 N 5TH STR #1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2005
Practice Address - Country:US
Practice Address - Phone:662-328-1825
Practice Address - Fax:662-328-1825
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1676-751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice