Provider Demographics
NPI:1942453691
Name:RONALD T. OGLESBY, D.D.S.
Entity Type:Organization
Organization Name:RONALD T. OGLESBY, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-875-6504
Mailing Address - Street 1:900 W. ENNIS AVE.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119
Mailing Address - Country:US
Mailing Address - Phone:972-875-6504
Mailing Address - Fax:972-875-6504
Practice Address - Street 1:900 W. ENNIS AVE.
Practice Address - Street 2:SUITE 105
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119
Practice Address - Country:US
Practice Address - Phone:972-875-6504
Practice Address - Fax:972-875-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1730234600Medicaid