Provider Demographics
NPI:1750772166
Name:DEOGSOO ROH, DDS, INC
Entity type:Organization
Organization Name:DEOGSOO ROH, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEOGSOO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-875-8268
Mailing Address - Street 1:625 P ST
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-2823
Mailing Address - Country:US
Mailing Address - Phone:559-875-8268
Mailing Address - Fax:559-875-9437
Practice Address - Street 1:625 P ST
Practice Address - Street 2:
Practice Address - City:SANGER
Practice Address - State:CA
Practice Address - Zip Code:93657-2823
Practice Address - Country:US
Practice Address - Phone:559-875-8268
Practice Address - Fax:559-875-9437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-08
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46426122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty