Provider Demographics
NPI:1477669562
Name:BAE AND BAE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:BAE AND BAE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WON
Authorized Official - Middle Name:H
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-485-2278
Mailing Address - Street 1:320 BOLTON ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3980
Mailing Address - Country:US
Mailing Address - Phone:508-485-2278
Mailing Address - Fax:508-485-0970
Practice Address - Street 1:320 BOLTON ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3980
Practice Address - Country:US
Practice Address - Phone:508-485-2278
Practice Address - Fax:508-485-0970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11783122300000X
MA19091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty