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 1:1405 COMMERCIAL WAY
Mailing Address - Street 2:SUITE NUMBER 140
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309
Mailing Address - Country:US
Mailing Address - Phone:661-328-9993
Mailing Address - Fax:661-328-8838
Practice Address - Street 1:1405 COMMERCIAL WAY
Practice Address - Street 2:SUITE NUMBER 140
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-328-9993
Practice Address - Fax:661-328-8838
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA402061223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0700XDental ProvidersDentistProsthodontics