Provider Demographics
NPI:1417512104
Name:BAIK, JUSTIN J (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:J
Last Name:BAIK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S RANDALL RD STE G
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-4607
Mailing Address - Country:US
Mailing Address - Phone:847-372-5818
Mailing Address - Fax:
Practice Address - Street 1:400 S RANDALL RD STE G
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4607
Practice Address - Country:US
Practice Address - Phone:224-629-4125
Practice Address - Fax:224-601-8506
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA611366031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty