MEDICARE: ALBERT OH DENTISTRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1184133076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALBERT OH DENTISTRY PC

Provider Business Mailing Address
First Line	:	531 W LAS TUNAS DR STE A
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1166
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	531 W LAS TUNAS DR STE A
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1166
Country	:	US
Telephone Number	:	626-282-0884
Fax Number	:

Authorized Official
Title or Position	:	CEO PRESIDENT SECRETARY
Name	:	DR. ALBERT OH
Credential	:	DDS
Telephone Number	:	714-323-8007

Provider Enumeration Date	:	09/24/2017
Last Update Date	:	09/24/2017

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