Provider Demographics
NPI:1518220045
Name:OG GROUPS, PLLC
Entity Type:Organization
Organization Name:OG GROUPS, PLLC
Other - Org Name:OG DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER OF PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-510-7650
Mailing Address - Street 1:40 NOUVELLE WAY
Mailing Address - Street 2:UNIT 944
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1571
Mailing Address - Country:US
Mailing Address - Phone:617-510-7650
Mailing Address - Fax:
Practice Address - Street 1:40 CENTRE ST
Practice Address - Street 2:SUITE #1
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2804
Practice Address - Country:US
Practice Address - Phone:617-505-6530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN222561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty