Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | DN20042 | FL |
N | 213EG0000X | General Practice | DN20042 | FL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2901600263 | MI |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN20042 | FL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 4301116139 | MI |
N | 204E00000X | Oral & Maxillofacial Surgeon | TRN23463 | FL |
NPI | 1508124363 |
---|---|
Provider Name | Dr. Marek Jaroslaw Ogledzki |
First Address | Orange Park, FL 32073-5558 |
Second Address | Orange Park, FL 32073-5558 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2012 |
Last Update Date | 17/08/2021 |