Provider Demographics
NPI:1285787689
Name:OGUERI, UDO P (DDS)
Entity type:Individual
Prefix:DR
First Name:UDO
Middle Name:P
Last Name:OGUERI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 DULUTH HWY # 120
Mailing Address - Street 2:SUITE 703
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3328
Mailing Address - Country:US
Mailing Address - Phone:770-962-8835
Mailing Address - Fax:770-995-9436
Practice Address - Street 1:665 DULUTH HWY # 120
Practice Address - Street 2:SUITE 703
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3328
Practice Address - Country:US
Practice Address - Phone:770-962-8835
Practice Address - Fax:770-995-9436
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1738437OtherUNITED CONCORDIA PROVIDER