Provider Demographics
NPI:1194946335
Name:BAE, PETER S (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:BAE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3002
Mailing Address - Country:US
Mailing Address - Phone:509-525-7250
Mailing Address - Fax:
Practice Address - Street 1:217 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3002
Practice Address - Country:US
Practice Address - Phone:509-525-7250
Practice Address - Fax:509-526-5295
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA402061223P0700X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics