Healthcare Provider Details

I. General information

NPI: 1396650214
Provider Name (Legal Business Name): BRYAN HYUNJOONG OH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 TAMARACK RD
SILVER SPRING MD
20904-1540
US

IV. Provider business mailing address

12901 TAMARACK RD
SILVER SPRING MD
20904-1540
US

V. Phone/Fax

Practice location:
  • Phone: 301-384-6776
  • Fax: 301-384-6778
Mailing address:
  • Phone: 301-384-6776
  • Fax: 301-384-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18948
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: