Provider Demographics
NPI:1891845467
Name:OGEMBO, JANE A (DDS)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:A
Last Name:OGEMBO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CONKEY AVE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1762
Mailing Address - Country:US
Mailing Address - Phone:607-337-4174
Mailing Address - Fax:
Practice Address - Street 1:32 CONKEY AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1762
Practice Address - Country:US
Practice Address - Phone:607-337-4174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist