Provider Demographics
NPI:1265603773
Name:JACK B. OH, DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JACK B. OH, DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:B
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-444-9400
Mailing Address - Street 1:2705 S DIAMOND BAR BLVD STE 288
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3555
Mailing Address - Country:US
Mailing Address - Phone:909-444-9400
Mailing Address - Fax:909-444-3311
Practice Address - Street 1:2705 S DIAMOND BAR BLVD STE 288
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3555
Practice Address - Country:US
Practice Address - Phone:909-444-9400
Practice Address - Fax:909-444-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty