Provider Demographics
NPI:1487932547
Name:OH, KEVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 PADDLE CT
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4804
Mailing Address - Country:US
Mailing Address - Phone:321-287-8346
Mailing Address - Fax:
Practice Address - Street 1:170 BROOKLINE AVE
Practice Address - Street 2:UNIT 517
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3937
Practice Address - Country:US
Practice Address - Phone:321-287-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-23
Last Update Date:2022-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855931122300000X
390200000X
GADN0151501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program