Provider Demographics
NPI:1619424520
Name:ROH, PATRICIA HAEMIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:HAEMIN
Last Name:ROH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5833
Mailing Address - Country:US
Mailing Address - Phone:201-437-3500
Mailing Address - Fax:
Practice Address - Street 1:711 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5833
Practice Address - Country:US
Practice Address - Phone:201-437-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027304001223G0001X
PADS041046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist