Provider Demographics
NPI:1760659296
Name:ROH, ALEX K (DMD, CAGS)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:K
Last Name:ROH
Suffix:
Gender:M
Credentials:DMD, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8061 KELSEY PL
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2619
Mailing Address - Country:US
Mailing Address - Phone:617-838-4854
Mailing Address - Fax:
Practice Address - Street 1:655 JESSE JEWELL PKWY SE STE D
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3854
Practice Address - Country:US
Practice Address - Phone:770-287-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0153161223P0221X
TX274971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286197303Medicaid
MA0221163Medicaid