Provider Demographics
NPI:1386007490
Name:DR. OGUFERE DDS, P.C
Entity Type:Organization
Organization Name:DR. OGUFERE DDS, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:UHONMOSEN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUFERE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-855-1556
Mailing Address - Street 1:6695 GRAND AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5268
Mailing Address - Country:US
Mailing Address - Phone:847-855-1445
Mailing Address - Fax:847-855-1423
Practice Address - Street 1:6695 GRAND AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5268
Practice Address - Country:US
Practice Address - Phone:847-855-1445
Practice Address - Fax:847-855-1423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.026580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty