Basic Information
| Provider Information | |||||||||
| NPI: | 1508124363 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OGLEDZKI | ||||||||
| FirstName: | MAREK | ||||||||
| MiddleName: | JAROSLAW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 MORRIS ST STE 309 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253011853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043883290 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 415 MORRIS ST STE 309 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253011853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043883290 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2012 | ||||||||
| LastUpdateDate: | 10/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN20042 | FL | N | Dental Providers | Dentist | General Practice | 1223S0112X | 31800 | WV | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | 2901600263 | MI | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | DN20042 | FL | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 204E00000X | TRN23463 | FL | N | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | 204E00000X | 4301116139 | MI | N | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | 1223S0112X | 4592 | WV | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.