Provider Demographics
NPI:1528145976
Name:OGDEN FAMILY DENTAL PLC
Entity type:Organization
Organization Name:OGDEN FAMILY DENTAL PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:PLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-275-2250
Mailing Address - Street 1:237 W MULBERRY
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:IA
Mailing Address - Zip Code:50212-0813
Mailing Address - Country:US
Mailing Address - Phone:515-275-2250
Mailing Address - Fax:515-275-2816
Practice Address - Street 1:237 W MULBERRY
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:IA
Practice Address - Zip Code:50212-0813
Practice Address - Country:US
Practice Address - Phone:515-275-2250
Practice Address - Fax:515-275-2816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADR MARK W PLATT 6772122300000X
IADR JEFF GRAGG 08240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0193672Medicaid
IA19367OtherWELLMARK BCBS