Provider Demographics
NPI:1831306844
Name:OH, EUNSEOK (DDS)
Entity Type:Individual
Prefix:MR
First Name:EUNSEOK
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:EUGENE
Other - Middle Name:
Other - Last Name:OH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:301 MAPLE AVE WEST
Mailing Address - Street 2:STE 440
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:703-539-9166
Mailing Address - Fax:
Practice Address - Street 1:301 MAPLE AVE WEST
Practice Address - Street 2:STE 440
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180
Practice Address - Country:US
Practice Address - Phone:703-539-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052163122300000X
VA04014127961223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist