Healthcare Provider Details

I. General information

NPI: 1336495670
Provider Name (Legal Business Name): SINHEE BAE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 BROAD ST
LYNN MA
01902-5003
US

IV. Provider business mailing address

1090 NORTHCHASE PKWY SE STE 290
MARIETTA GA
30067-6402
US

V. Phone/Fax

Practice location:
  • Phone: 781-599-2900
  • Fax:
Mailing address:
  • Phone: 770-916-5352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401413712
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1452390
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: