Provider Demographics
NPI:1205356805
Name:BAE'S DENTAL PA
Entity Type:Organization
Organization Name:BAE'S DENTAL PA
Other - Org Name:HIQ DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIWUK
Authorized Official - Middle Name:
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-242-0800
Mailing Address - Street 1:2625 OLD DENTON RD STE 416
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5112
Mailing Address - Country:US
Mailing Address - Phone:972-242-0800
Mailing Address - Fax:
Practice Address - Street 1:2625 OLD DENTON RD STE 416
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5112
Practice Address - Country:US
Practice Address - Phone:972-242-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22182261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental