Provider Demographics
NPI:1982085056
Name:OH, SEO JIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEO
Middle Name:JIN
Last Name:OH
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 1:2967 PHILADELPHIA DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6813
Mailing Address - Country:US
Mailing Address - Phone:734-358-2117
Mailing Address - Fax:
Practice Address - Street 1:2967 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6813
Practice Address - Country:US
Practice Address - Phone:734-358-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021555122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist