Geon Bae, D.M.D

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

139529 Issued in AK

Practice address

3340 Providence Dr Ste 552
Anchorage, AK 99508

Phone

(907) 336-1234

Fax

(907) 336-4321

NPI assigned

Feb 9, 2016

Last updated

May 17, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in AK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pediatric Dentistry of Alaska

  • Dental Clinic/Center
  • Wasilla, AK
  • NPI 1568616548

  Pediatric Dentistry

  NPD (past)

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

{
    "created_epoch": "1454976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621209600000",
    "number": "1811355456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3470 E MERIDIAN PARK LOOP",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996547294",
            "telephone_number": "907-373-8684",
            "fax_number": "907-373-8465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 PROVIDENCE DR STE 552",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99508",
            "telephone_number": "907-336-1234",
            "fax_number": "907-336-4321"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1127 Wilshire Blvd",
            "address_2": "Ste. 1504",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900173901",
            "country_code": "US",
            "telephone_number": "213-201-1388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4441 Diplomacy Dr",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995085910",
            "country_code": "US",
            "telephone_number": "907-729-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3470 E Meridian Park Loop",
            "address_purpose": "LOCATION",
            "city": "Wasilla",
            "state": "AK",
            "postal_code": "996547294",
            "country_code": "US",
            "telephone_number": "907-373-8684",
            "fax_number": "907-373-8465",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAE",
        "first_name": "GEON",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-09",
        "last_updated": "2021-05-17",
        "certification_date": "2021-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AK",
            "license": "139529",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AK",
            "license": "139529",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Bacon
• Kal Bacon
• Kristin M Bacon, PT
• Johanna Badalich
• Mia Badillo
• Raquel Baez Baez
• Laura Baez, LCSW
• Courtney Weathersby Bagayoko, M.D.
• Namory Bagayoko, MD
• Nicole Bagg

• Pediatric Dentistry in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Pediatric Dentistry in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.