Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22DI02571500 | NJ |
N | 1223P0700X | Prosthodontist | 056707 | NY |
NPI | 1043652886 |
---|---|
Provider Name | Dr. Francis Oh |
First Address | Fort Lee, NJ 07024-4930 |
Second Address | Fort Lee, NJ 07024-4930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2013 |
Last Update Date | 16/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056707 | NYS DENTAL LICENSE (01) | NY |
22DI02571500 | NJ LICENSING BOARD (01) | NJ |