Su Jin Bae, DDS
Individual provider Active NPI Dentist · Natick, MA
NPI 1962959320 · NPPES record last updated Jun 22, 2024
Key facts
- NPI
- 1962959320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN1857747 (MA)
- Practice address
- 14 W Central St
Natick, MA 01760-4514 - Phone
- (508) 720-5000
- NPI assigned
- Sep 2, 2016
- 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 |
|---|---|---|---|
| DN1857747 | MA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Natick Family Dental PC | Dentist | Current |
Accepting new patients |
Locations
14 W Central St
Natick, MA 01760
Phone (508) 653-7311
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN1857747 | MA | Yes |
Addresses
Primary practice location
14 W Central St
Natick, MA 01760-4514
Mailing address
14 W Central St
Natick, MA 01760-4514
Phone (508) 720-5000
Other providers in Natick, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 22, 2024. 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.