Provider Demographics
NPI:1275080004
Name:BAE, GINA (DDS)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BAE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ACKERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1501
Mailing Address - Country:US
Mailing Address - Phone:973-531-4444
Mailing Address - Fax:973-531-4000
Practice Address - Street 1:41 ACKERMAN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-1501
Practice Address - Country:US
Practice Address - Phone:973-531-4444
Practice Address - Fax:973-531-4000
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026506001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice