Healthcare Provider Details

I. General information

NPI: 1033802830
Provider Name (Legal Business Name): DR. JESSICA OH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 WOODSTOCK RD STE 350
ROSWELL GA
30075-8222
US

IV. Provider business mailing address

311 LA PERLA DR
SUGAR HILL GA
30518-6161
US

V. Phone/Fax

Practice location:
  • Phone: 770-992-3353
  • Fax:
Mailing address:
  • Phone: 678-350-8876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124027
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: