Provider Demographics
NPI:1083117337
Name:BAE, ALEXANDER (DDS)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
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 1:123 CHAMBERS ST FRNT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1080
Mailing Address - Country:US
Mailing Address - Phone:212-254-1234
Mailing Address - Fax:
Practice Address - Street 1:123 CHAMBERS ST FRNT 1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1080
Practice Address - Country:US
Practice Address - Phone:212-257-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-13
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0622891223G0001X, 1223G0001X
CODEN.002039811223G0001X
MI29016001371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice