Provider Demographics
NPI:1598338865
Name:OH, RYAN DAE HEON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:DAE HEON
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 1:3033 OHIO DR APT 1048
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6335
Mailing Address - Country:US
Mailing Address - Phone:201-704-7011
Mailing Address - Fax:
Practice Address - Street 1:4470 W JEFFERSON BLVD STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-4616
Practice Address - Country:US
Practice Address - Phone:214-420-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX375891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice