Provider Demographics
NPI:1538680632
Name:CONNIE OH DDS MS
Entity type:Organization
Organization Name:CONNIE OH DDS MS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:510-522-3545
Mailing Address - Street 1:2238 SANTA CLARA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4464
Mailing Address - Country:US
Mailing Address - Phone:510-522-3545
Mailing Address - Fax:510-522-2291
Practice Address - Street 1:2238 SANTA CLARA AVE STE C
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4464
Practice Address - Country:US
Practice Address - Phone:510-522-3545
Practice Address - Fax:510-522-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty