Provider Demographics
NPI:1568847069
Name:OH, SARA HYUN SEUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:HYUN SEUNG
Last Name:OH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6348 SUNNYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4466
Mailing Address - Country:US
Mailing Address - Phone:615-525-7777
Mailing Address - Fax:
Practice Address - Street 1:1692 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042
Practice Address - Country:US
Practice Address - Phone:931-552-7745
Practice Address - Fax:931-645-3545
Is Sole Proprietor?:No
Enumeration Date:2015-07-25
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD43671223G0001X
TN106071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice