Provider Demographics
NPI:1730107772
Name:LOH, WILFRED (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:
Last Name:LOH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2787 KENNEDY BLVD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5531
Mailing Address - Country:US
Mailing Address - Phone:201-653-1220
Mailing Address - Fax:
Practice Address - Street 1:2787 KENNEDY BLVD
Practice Address - Street 2:SUITE 13
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5531
Practice Address - Country:US
Practice Address - Phone:201-653-1220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ131601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice