Provider Demographics
NPI:1497370621
Name:OH, JEONG TEAG (DDS)
Entity Type:Individual
Prefix:
First Name:JEONG TEAG
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FRANKLIN ST APT 2203
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1469
Mailing Address - Country:US
Mailing Address - Phone:317-579-5900
Mailing Address - Fax:
Practice Address - Street 1:150 GODDARD MEMORIAL DR STE 2
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1260
Practice Address - Country:US
Practice Address - Phone:508-796-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist