Provider Demographics
NPI:1871079681
Name:OH, LOLA HYEJI (DMD)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:HYEJI
Last Name:OH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 DAHLGREN ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1613
Mailing Address - Country:US
Mailing Address - Phone:404-216-5423
Mailing Address - Fax:
Practice Address - Street 1:4260 PEACHTREE RD NE STE 200
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3783
Practice Address - Country:US
Practice Address - Phone:404-968-9929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist