Provider Demographics
NPI:1881835221
Name:JO, SEHEUI (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEHEUI
Middle Name:
Last Name:JO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 S COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-5551
Mailing Address - Country:US
Mailing Address - Phone:631-475-1191
Mailing Address - Fax:
Practice Address - Street 1:680 S COUNTRY RD
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-5551
Practice Address - Country:US
Practice Address - Phone:631-475-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052047-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice