Provider Demographics
NPI:1225226566
Name:SAEKYU OH DMD DENTAL CORP
Entity Type:Organization
Organization Name:SAEKYU OH DMD DENTAL CORP
Other - Org Name:SMILEWORLD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWENER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAEKYU
Authorized Official - Middle Name:
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-323-1111
Mailing Address - Street 1:4104 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1014
Mailing Address - Country:US
Mailing Address - Phone:661-323-2223
Mailing Address - Fax:
Practice Address - Street 1:4104 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1014
Practice Address - Country:US
Practice Address - Phone:661-323-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92452OtherDENTICAL/HEALTHY FAMILIES