Provider Demographics
NPI:1508124363
Name:OGLEDZKI, MAREK JAROSLAW (MD, DMD)
Entity Type:Individual
Prefix:DR
First Name:MAREK
Middle Name:JAROSLAW
Last Name:OGLEDZKI
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MORRIS ST STE 309
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1853
Mailing Address - Country:US
Mailing Address - Phone:304-388-3290
Mailing Address - Fax:
Practice Address - Street 1:415 MORRIS ST STE 309
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1853
Practice Address - Country:US
Practice Address - Phone:304-388-3290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2022-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN200421223G0001X, 1223S0112X
WV318001223S0112X
MI29016002631223S0112X
FLTRN23463204E00000X
MI4301116139204E00000X
WV45921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery