Provider Demographics
NPI:1780812800
Name:JUN TAE BAE, DDS, LLC
Entity type:Organization
Organization Name:JUN TAE BAE, DDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN
Authorized Official - Middle Name:TAE
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-527-8664
Mailing Address - Street 1:501 N FREDERICK AVE
Mailing Address - Street 2:SUITE #109
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2507
Mailing Address - Country:US
Mailing Address - Phone:301-527-8664
Mailing Address - Fax:301-527-9365
Practice Address - Street 1:501 N FREDERICK AVE
Practice Address - Street 2:SUITE #109
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2507
Practice Address - Country:US
Practice Address - Phone:301-527-8664
Practice Address - Fax:301-527-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty