Provider Demographics
NPI:1194933291
Name:AESTHETICS DENTISTRY,INC.
Entity type:Organization
Organization Name:AESTHETICS DENTISTRY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-635-9414
Mailing Address - Street 1:11410 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3030
Mailing Address - Country:US
Mailing Address - Phone:425-635-9414
Mailing Address - Fax:425-688-1657
Practice Address - Street 1:11410 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3030
Practice Address - Country:US
Practice Address - Phone:425-635-9414
Practice Address - Fax:425-688-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE7058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty