Provider Demographics
NPI:1649868159
Name:OH, MIN (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:MIN
Middle Name:
Last Name:OH
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2896 DILLON DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3708
Mailing Address - Country:US
Mailing Address - Phone:734-846-6156
Mailing Address - Fax:
Practice Address - Street 1:3201 BEMIS RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9307
Practice Address - Country:US
Practice Address - Phone:734-572-9532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-10
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE.61126175122300000X
CODEN.00204551122300000X
WADENT.DE.61126175122300000X
MI2901601001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist