Provider Demographics
NPI:1215064860
Name:OGILVIE, RALPH W (DMD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:W
Last Name:OGILVIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-0310
Mailing Address - Country:US
Mailing Address - Phone:435-654-4004
Mailing Address - Fax:435-654-4084
Practice Address - Street 1:425 EAST 1200 SOUTH
Practice Address - Street 2:
Practice Address - City:HEBER
Practice Address - State:UT
Practice Address - Zip Code:84032
Practice Address - Country:US
Practice Address - Phone:435-654-4004
Practice Address - Fax:435-654-4084
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT261426-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice