Provider Demographics
NPI:1871827840
Name:OH, HYESUK (DDS)
Entity Type:Individual
Prefix:
First Name:HYESUK
Middle Name:
Last Name:OH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 UNION ST STE 1016
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1293
Mailing Address - Country:US
Mailing Address - Phone:203-574-2121
Mailing Address - Fax:
Practice Address - Street 1:495 UNION ST STE 1016
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1293
Practice Address - Country:US
Practice Address - Phone:203-574-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0100971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice