Provider Demographics
NPI:1194105809
Name:OH, SAMUEL BO RUM (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BO RUM
Last Name:OH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17569 FISHTRAP RD STE 80
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-5122
Mailing Address - Country:US
Mailing Address - Phone:469-519-9951
Mailing Address - Fax:
Practice Address - Street 1:3620 W 1ST ST STE 40
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-3493
Practice Address - Country:US
Practice Address - Phone:469-519-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-1531223P0221X
TX331651223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry