Healthcare Provider Details

I. General information

NPI: 1760172779
Provider Name (Legal Business Name): YEU JIN BAIK, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2023
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 E SOUTHLAKE BLVD STE 100
SOUTHLAKE TX
76092-6272
US

IV. Provider business mailing address

271 E SOUTHLAKE BLVD STE 100
SOUTHLAKE TX
76092-6272
US

V. Phone/Fax

Practice location:
  • Phone: 817-329-6677
  • Fax:
Mailing address:
  • Phone: 817-329-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. YEU JIN BAIK
Title or Position: DENTIST
Credential: DDS
Phone: 516-640-6812