Provider Demographics
NPI:1518469667
Name:OGAWA, JUNKO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUNKO
Middle Name:
Last Name:OGAWA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1956
Mailing Address - Country:US
Mailing Address - Phone:617-359-9129
Mailing Address - Fax:
Practice Address - Street 1:156 SUMNER ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-1956
Practice Address - Country:US
Practice Address - Phone:617-359-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN17971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist