Provider Demographics
NPI:1598719288
Name:OH, DANIEL SHIN (DDS)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:SHIN
Last Name:OH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:SHIN
Other - Middle Name:SOP
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1883 WILLOWVIEW TER
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2934
Mailing Address - Country:US
Mailing Address - Phone:847-309-3446
Mailing Address - Fax:
Practice Address - Street 1:1883 WILLOWVIEW TER
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-2934
Practice Address - Country:US
Practice Address - Phone:847-309-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist