Provider Demographics
NPI:1467646547
Name:BAE, THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
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 1:277 W PEBBLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1095
Mailing Address - Country:US
Mailing Address - Phone:310-869-4161
Mailing Address - Fax:
Practice Address - Street 1:355 SOUTH LEMON AVENUE
Practice Address - Street 2:SUITE P
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789
Practice Address - Country:US
Practice Address - Phone:909-598-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist