MEDICARE: DR. PETER S BAEK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019023779	IL

General Provider Information

NPI Number	:	1821123761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER S BAEK D.D.S.

Provider Business Mailing Address
First Line	:	9694 REDING CIR
Second Line	:
City	:	DES PLAINES
State	:	IL
Zip	:	60016-1551
Country	:	US
Telephone Number	:	847-738-8353
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 E. RAND RD.
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004
Country	:	US
Telephone Number	:	847-392-4422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	10/16/2024

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