Provider Demographics
NPI:1841560919
Name:OH, YOUNGJU (DMD)
Entity Type:Individual
Prefix:DR
First Name:YOUNGJU
Middle Name:
Last Name:OH
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 1:1335 N BELT LINE RD STE 16
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-4037
Mailing Address - Country:US
Mailing Address - Phone:917-282-8712
Mailing Address - Fax:
Practice Address - Street 1:1335 N BELT LINE RD STE 16
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4037
Practice Address - Country:US
Practice Address - Phone:972-600-8002
Practice Address - Fax:972-600-8036
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10686122300000X
TX30423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist