Healthcare Provider Details

I. General information

NPI: 1477669562
Provider Name (Legal Business Name): BAE AND BAE FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 BOLTON ST
MARLBOROUGH MA
01752-3980
US

IV. Provider business mailing address

320 BOLTON ST
MARLBOROUGH MA
01752-3980
US

V. Phone/Fax

Practice location:
  • Phone: 508-485-2278
  • Fax: 508-485-0970
Mailing address:
  • Phone: 508-485-2278
  • Fax: 508-485-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number19091
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11783
License Number StateMA

VIII. Authorized Official

Name: DR. WON H BAE
Title or Position: PARTNER
Credential: DDS
Phone: 508-485-2278