1780812800 NPI number — JUN TAE BAE, DDS, LLC

Table of content: (NPI 1780812800)

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)





Copyright © 2007-2024 www.npivalidator.com