Provider Demographics
NPI:1225293368
Name:OH, TIMOTHY (DMD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 BEECHLAND RD
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-2533
Mailing Address - Country:US
Mailing Address - Phone:207-667-6789
Mailing Address - Fax:207-667-8875
Practice Address - Street 1:72 BEECHLAND RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2533
Practice Address - Country:US
Practice Address - Phone:207-667-6789
Practice Address - Fax:207-667-8875
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7613122300000X
MEDEN40691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist