Provider Demographics
NPI:1003990623
Name:BAI, QIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:QIN
Middle Name:
Last Name:BAI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:QIN
Other - Last Name:BAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:800 COTTAGE GROVE RD
Mailing Address - Street 2:STE 311
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002
Mailing Address - Country:US
Mailing Address - Phone:860-242-8333
Mailing Address - Fax:860-286-8033
Practice Address - Street 1:800 COTTAGE GROVE RD
Practice Address - Street 2:STE 311
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002
Practice Address - Country:US
Practice Address - Phone:860-242-8333
Practice Address - Fax:860-286-8033
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8273122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist