Provider Demographics
NPI:1346695616
Name:BAE DENTAL ASSOCIATES-WESTMINSTER LLC
Entity Type:Organization
Organization Name:BAE DENTAL ASSOCIATES-WESTMINSTER LLC
Other - Org Name:FAMILY DENTISTRY OF WESTMINSTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUN
Authorized Official - Middle Name:TAE
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-876-1747
Mailing Address - Street 1:532 BALTIMORE BLVD
Mailing Address - Street 2:412
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6117
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:532 BALTIMORE BLVD
Practice Address - Street 2:412
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6117
Practice Address - Country:US
Practice Address - Phone:443-603-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty