Provider Demographics
NPI:1679961866
Name:BAE, D.D.S., L.L.C
Entity type:Organization
Organization Name:BAE, D.D.S., L.L.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN
Authorized Official - Middle Name:TAE
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-603-9000
Mailing Address - Street 1:200 FORBES ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1538
Mailing Address - Country:US
Mailing Address - Phone:443-603-9000
Mailing Address - Fax:443-603-9010
Practice Address - Street 1:200 FORBES ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1538
Practice Address - Country:US
Practice Address - Phone:443-603-9000
Practice Address - Fax:443-603-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty