Provider Demographics
NPI:1275957532
Name:BAEK DENTAL, P.C.
Entity Type:Organization
Organization Name:BAEK DENTAL, P.C.
Other - Org Name:PAUL W. BAEK, D.M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WOOJONG
Authorized Official - Last Name:BAEK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-630-2828
Mailing Address - Street 1:1400 CENTRE ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2454
Mailing Address - Country:US
Mailing Address - Phone:617-630-2828
Mailing Address - Fax:
Practice Address - Street 1:1400 CENTRE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459-2454
Practice Address - Country:US
Practice Address - Phone:617-630-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN20938261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental