Organization Name: | BAEK DENTAL, P.C. |
NPI Number: | 1275957532 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAUL WOOJONG BAEK (DENTIST/OWNER) |
Mailing Address: | 1400 Centre St Suite 106 Newton Centre |
State: | MA US |
Postal Code: | 024592454 |
Phone Number: | 6176302828 |
Fax Number: | |
NPI Enumeration Date: | 02/07/2014 |
NPI Last Update Date: | 02/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | DN20938 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |