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General NPI Number Information
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NPI Number | 1336710441
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Entity Type | Individual
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Provider Name | KYUNGTAEK BAEK DMD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 07/08/2021
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Provider Practice Location Address
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Address Line | 2005 BOGGS RD # 104-107
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City | DULUTH
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State | GA
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Zip | 30096-4601
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Country | US
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Telephone | 770-497-0085
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Fax |
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Provider Business Mailing Address
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Address Line | 2856 LANDINGTON WAY
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City | DULUTH
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State | GA
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Zip | 30096-6218
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Country | US
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Telephone | 404-717-9341
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN122316
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License Number State | GA
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