Provider Demographics
NPI:1568501872
Name:ROH, DEOGSOO (DDS)
Entity Type:Individual
Prefix:
First Name:DEOGSOO
Middle Name:
Last Name:ROH
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 1:625 P ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2823
Mailing Address - Country:US
Mailing Address - Phone:559-875-8268
Mailing Address - Fax:559-875-9437
Practice Address - Street 1:625 P ST
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2823
Practice Address - Country:US
Practice Address - Phone:559-875-8268
Practice Address - Fax:559-875-9437
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA464261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice