Provider Demographics
NPI:1528475894
Name:BAEK, JULIA J
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:J
Last Name:BAEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 W FLAMINGO RD
Mailing Address - Street 2:STE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-0169
Mailing Address - Country:US
Mailing Address - Phone:702-876-3222
Mailing Address - Fax:702-876-4422
Practice Address - Street 1:5680 W FLAMINGO RD
Practice Address - Street 2:A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-0169
Practice Address - Country:US
Practice Address - Phone:702-876-3222
Practice Address - Fax:702-876-4422
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65291223G0001X
NVS6-1751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice