Provider Demographics
NPI:1013952068
Name:BAE, JUN TAE (DDS)
Entity Type:Individual
Prefix:
First Name:JUN
Middle Name:TAE
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 1:13974 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5086
Mailing Address - Country:US
Mailing Address - Phone:301-490-8200
Mailing Address - Fax:301-490-4300
Practice Address - Street 1:13974 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5086
Practice Address - Country:US
Practice Address - Phone:301-490-8200
Practice Address - Fax:301-490-4300
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice