Provider Demographics
NPI:1487105136
Name:HUGH OGLETREE JR DMD MS PA
Entity type:Organization
Organization Name:HUGH OGLETREE JR DMD MS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLETREE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-540-5440
Mailing Address - Street 1:10700 KETTERING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:704-540-5440
Mailing Address - Fax:704-540-5441
Practice Address - Street 1:10700 KETTERING DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-540-5440
Practice Address - Fax:704-540-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487063426Medicaid
NC1225416589Medicaid
NC5910013Medicaid