Provider Demographics
NPI:1306074356
Name:SAM OH,DMD,INC
Entity type:Organization
Organization Name:SAM OH,DMD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-659-8548
Mailing Address - Street 1:5929 EVERGREEN WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6031
Mailing Address - Country:US
Mailing Address - Phone:360-659-8548
Mailing Address - Fax:360-653-6112
Practice Address - Street 1:5929 EVERGREEN WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6031
Practice Address - Country:US
Practice Address - Phone:360-659-8548
Practice Address - Fax:360-653-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty