Provider Demographics
NPI:1932349990
Name:OH, SUSAN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:OH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 JUANA AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4841
Mailing Address - Country:US
Mailing Address - Phone:510-483-2670
Mailing Address - Fax:510-483-1566
Practice Address - Street 1:250 JUANA AVE
Practice Address - Street 2:STE 102
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4841
Practice Address - Country:US
Practice Address - Phone:510-483-2670
Practice Address - Fax:510-483-1566
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-12-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA579051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice