Suho Bae, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DD4780 Issued in NM

Practice address

1508 N Riverside Dr
Espanola, NM 87532-2064

Phone

(888) 988-4066

Fax

(847) 496-4850

NPI assigned

Aug 10, 2017

Last updated

Aug 16, 2017By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NM

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.

• Familia Dental Esp LLC

  dba Familia Dental

  • Dental Clinic/Center
  • Espanola, NM
  • NPI 1356634703

  General Practice

  NPD (past)

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

{
    "created_epoch": "1502323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502841600000",
    "number": "1841715992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 E ALGONQUIN RD STE 610",
            "city": "SCHAUMBURG",
            "state": "IL",
            "postal_code": "601734166",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-4850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 N RIVERSIDE DR",
            "city": "ESPANOLA",
            "state": "NM",
            "postal_code": "875322064",
            "telephone_number": "888-988-4066",
            "fax_number": "847-496-4850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAE",
        "first_name": "SUHO",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-10",
        "last_updated": "2017-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "DD4780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ayudantes
• Ayudantes Inc
• Bernadine Baca
• Celeste Baca, LMSW
• Meredith Baca, LPCC, LPC
• Ida Baldonado
• Yevgeni Balicek
• Vianey Barajas, CCSS
• Victoria Baros
• Biatris Barrera, MD

• General Practice Dentistry in Espanola, NM
• Providers in Espanola, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2017; 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.