Sang Bae, DDS
Individual provider Active NPI General Practice Dentistry · Bothell, WA
NPI 1104147016 · NPPES record last updated Jun 15, 2010
Key facts
- NPI
- 1104147016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DE 60056965 (WA)
- Practice address
- 1729 208TH St SE
#101
Bothell, WA 98012-7789 - Phone
- (425) 485-8885
- NPI assigned
- Jun 15, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE 60056965 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gary Eldon Heyamoto | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE 60056965 | WA | Yes |
Addresses
Primary practice location
1729 208TH St SE
#101
Bothell, WA 98012-7789
Mailing address
13426 64TH Ave W
Edmonds, WA 98026-3246
Other providers in Bothell, WA
- Avenue Healthcare Staffing,LLC
- Summer Avey
- B'Zoe Inc.
- Anna Arlene Babcock
- Nataliya Badowski
- Alexis Catalina Bailey
- Jason Christopher Bailey
- Daniel Baker
- Deborah D. Baker
- Melissa Doreen Baker
All providers in Bothell, WA · General Practice Dentistry in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.