Provider Demographics
NPI:1578651063
Name:OGRODNICK, DAVID MITCHELL (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MITCHELL
Last Name:OGRODNICK
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 GREAT RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5777
Mailing Address - Country:US
Mailing Address - Phone:978-263-3526
Mailing Address - Fax:978-263-5888
Practice Address - Street 1:179 GREAT RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5777
Practice Address - Country:US
Practice Address - Phone:978-263-3526
Practice Address - Fax:978-263-5888
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12231201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA515605OtherUNITED CONCORDIA
MAX03896OtherBC/BS OF MA