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General NPI Number Information
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NPI Number | 1952689507
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Entity Type | Individual
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Provider Name | MYUNGWON JOYCE BAEK DMD
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Gender | Female
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 1795 MAIN ST STE 116
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City | SPRINGFIELD
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State | MA
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Zip | 01103-1078
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Country | US
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Telephone | 413-439-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 17 CHERRY ST # R
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3201
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Country | US
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Telephone | 617-416-0973
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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 | DN1855783
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License Number State | MA
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