Provider Demographics
NPI:1609844505
Name:OH, JACK B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:B
Last Name:OH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2705 S DIAMOND BAR BLVD
Mailing Address - Street 2:SUITE 288
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3512
Mailing Address - Country:US
Mailing Address - Phone:909-444-9400
Mailing Address - Fax:909-444-3311
Practice Address - Street 1:2705 S DIAMOND BAR BLVD
Practice Address - Street 2:SUITE 288
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3512
Practice Address - Country:US
Practice Address - Phone:909-444-9400
Practice Address - Fax:909-444-3311
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA422051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice