Provider Demographics
NPI:1043730179
Name:OH, MICHELLE MI WON (DDS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MI WON
Last Name:OH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 29TH ST APT 5E
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3313
Mailing Address - Country:US
Mailing Address - Phone:631-258-4722
Mailing Address - Fax:
Practice Address - Street 1:3132 29TH ST APT 5E
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-3313
Practice Address - Country:US
Practice Address - Phone:631-258-4722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0602111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice