1780812800 NPI number — JUN TAE BAE, DDS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780812800 NPI number — JUN TAE BAE, DDS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUN TAE BAE, DDS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY DENTISTRY OF GAITHERSBURG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780812800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 N FREDERICK AVE
Provider Second Line Business Mailing Address:
SUITE #109
Provider Business Mailing Address City Name:
GAITHERSBURG
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20877-2507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-527-8664
Provider Business Mailing Address Fax Number:
301-527-9365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N FREDERICK AVE
Provider Second Line Business Practice Location Address:
SUITE #109
Provider Business Practice Location Address City Name:
GAITHERSBURG
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20877-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-527-8664
Provider Business Practice Location Address Fax Number:
301-527-9365
Provider Enumeration Date:
06/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BAE
Authorized Official First Name:
JUN
Authorized Official Middle Name:
TAE
Authorized Official Title or Position:
GENERAL DENTIST
Authorized Official Telephone Number:
301-527-8664

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  11589 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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