Provider Demographics
NPI:1235525858
Name:OH, MICHAEL MINSUK (DMD, MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:MINSUK
Last Name:OH
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:MINSUK
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MD
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-2332
Mailing Address - Country:US
Mailing Address - Phone:909-291-5733
Mailing Address - Fax:214-648-2918
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-2332
Practice Address - Country:US
Practice Address - Phone:214-645-3979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX358221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery