Provider Demographics
NPI:1902012941
Name:BAE, WON H (DDS)
Entity Type:Individual
Prefix:DR
First Name:WON
Middle Name:H
Last Name:BAE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 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
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA117831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice