Soo in Ahn, DMD
Individual provider Active NPI Dentist · Warwick, RI
NPI 1356070478 · NPPES record last updated Jul 12, 2022
Key facts
- NPI
- 1356070478
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DEN03617 (RI)
- Practice address
- 1000 Bald Hill Rd
Warwick, RI 02886-0506 - Phone
- (401) 822-1866
- NPI assigned
- Jun 6, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN1859464 | MA | MD | Dentist |
| DEN03617 | RI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sunny Smile Group II LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DEN03617 | RI | Yes |
| Dentist | 122300000X | DN1859464 | MA |
Addresses
Primary practice location
1000 Bald Hill Rd
Warwick, RI 02886-0506
Mailing address
31 Beach St Apt 805
Boston, MA 02111-1603
Phone (857) 265-9292
Other practice location 1
824 William S Canning Boulevard Ave
Fall River, MA 02721
Phone (508) 730-1800
Other providers in Warwick, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.