Larry S Wogman, DDS
Individual provider Active NPI Dentist · Mitchell, OR
NPI 1043545346 · NPPES record last updated Oct 5, 2009
Key facts
- NPI
- 1043545346
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D9235 (OR)
- Practice address
- 340 SE High St.
Mitchell, OR 97750-0304 - Phone
- (541) 462-3313
- NPI assigned
- Oct 5, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9235 | OR | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D9235 | OR | Yes |
Addresses
Primary practice location
340 SE High St.
Mitchell, OR 97750-0304
Mailing address
712 Jay St.
Fossil, OR 97830-0307
Phone (541) 763-2725
Other providers in Mitchell, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.