Provider Demographics
NPI:1124225560
Name:OH, ESTHER SEBUM (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:SEBUM
Last Name:OH
Suffix:
Gender:F
Credentials:DDS, MD
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Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:P.O. BOX 100416
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0416
Mailing Address - Country:US
Mailing Address - Phone:352-273-6750
Mailing Address - Fax:352-392-7609
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:DEPARTMENT OF ORAL MAXILLOFACIAL SURGERY
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0416
Practice Address - Country:US
Practice Address - Phone:352-273-6750
Practice Address - Fax:352-392-7609
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDT588122300000X, 1223S0112X
VA0101248090208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009159000Medicaid