Provider Demographics
NPI:1699147454
Name:OH, ALICE
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 LISBON CENTER DR
Mailing Address - Street 2:STE A & B
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8633
Mailing Address - Country:US
Mailing Address - Phone:410-489-2650
Mailing Address - Fax:
Practice Address - Street 1:708 LISBON CENTER DR
Practice Address - Street 2:STE A & B
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-8633
Practice Address - Country:US
Practice Address - Phone:410-489-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD155781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice