Provider Demographics
NPI:1962530006
Name:PAIK, AUGUSTINE W (DDS)
Entity type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:W
Last Name:PAIK
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 1:121 CONGRESSIONAL LN STE 304
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1542
Mailing Address - Country:US
Mailing Address - Phone:301-231-5858
Mailing Address - Fax:301-231-6171
Practice Address - Street 1:121 CONGRESSIONAL LN STE 304
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:301-231-5858
Practice Address - Fax:301-231-6171
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist