Healthcare Provider Details

I. General information

NPI: 1710181896
Provider Name (Legal Business Name): RYAN JOO YEUL BAEK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 WEST GERMANTOWN PIKE
EAST NORRITON PA
19401
US

IV. Provider business mailing address

207 WEST GERMANTOWN PIKE
EAST NORRITON PA
19401
US

V. Phone/Fax

Practice location:
  • Phone: 610-272-2235
  • Fax:
Mailing address:
  • Phone: 610-272-2235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS037069
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: