NPIMap

Organization Active NPI

Jun Tae Bae, DDS, PA

Doing business as Family Dentistry of Laurel

  • General Practice Dentistry
  • Laurel, MD
National Provider Identifier
1588954366
Registry record updated Apr 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11589 Issued in MD
Legal business name
JUN TAE BAE, DDS, PA
Doing business as
Family Dentistry of Laurel
Practice address
13974 Baltimore Ave
Laurel, MD 20707-5086
Phone
(301) 490-8200
Fax
(301) 490-4300
NPI assigned
Apr 13, 2011
Last updated
Apr 13, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jun Tae Bae, DDSNPI 1013952068
Title
Doctor
Phone
(301) 490-8200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 11589 MD Primary

Addresses

Primary practice location

13974 Baltimore Ave
Laurel, MD 20707-5086

Mailing address

13974 Baltimore Ave
Laurel, MD 20707-5086
Phone (301) 490-8200

Other identifiers 1

IdentifierTypeStateIssuer
013172500MedicaidMD

Other names 1

  • Family Dentistry of Laurel Doing business as

National Provider Directory

National Provider Directory

Locations

13974 Baltimore Ave
Laurel, MD 20707
Phone (301) 490-8200

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302652800000",
    "number": "1588954366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13974 BALTIMORE AVE",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075086",
            "telephone_number": "301-490-8200",
            "fax_number": "301-490-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13974 BALTIMORE AVE",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207075086",
            "telephone_number": "301-490-8200",
            "fax_number": "301-490-4300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUN TAE BAE, DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-13",
        "last_updated": "2011-04-13",
        "status": "A",
        "authorized_official_last_name": "BAE",
        "authorized_official_first_name": "JUN",
        "authorized_official_middle_name": "TAE",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "301-490-8200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "11589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013172500",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Dentistry of Laurel",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laurel, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.