Provider Demographics
NPI:1841020948
Name:ROH, JONGHYUN SAMUEL (DDS)
Entity type:Individual
Prefix:
First Name:JONGHYUN
Middle Name:SAMUEL
Last Name:ROH
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 1:416 BEARDS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035-2041
Mailing Address - Country:US
Mailing Address - Phone:443-875-6711
Mailing Address - Fax:
Practice Address - Street 1:14446 OLD MILL RD # 101
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3086
Practice Address - Country:US
Practice Address - Phone:301-952-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD182641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice