Provider Demographics
NPI:1831299403
Name:OGLETREE, HUGH EDWARD SR (DMD)
Entity type:Individual
Prefix:DR
First Name:HUGH
Middle Name:EDWARD
Last Name:OGLETREE
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:HUGH
Other - Middle Name:EDWARD
Other - Last Name:OGLETREE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1010 4TH PL
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36869-6985
Mailing Address - Country:US
Mailing Address - Phone:334-297-3277
Mailing Address - Fax:334-297-3279
Practice Address - Street 1:1010 4TH PL
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-6985
Practice Address - Country:US
Practice Address - Phone:334-297-3277
Practice Address - Fax:334-297-3279
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL652119Medicare UPIN