# BAEK DENTAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** RYAN BAEK DENTAL, LLC
- **Other names:** Ryan Baek Dental
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144619180
- **Legal business name:** RYAN BAEK DENTAL, LLC
- **Authorized official:** AERI (KATIE) BAEK (OFFICE MANAGER)
- **Authorized official phone:** (215) 643-0300

## Contact information

- **Practice address:** 428 PENNSYLVANIA AVE, FORT WASHINGTON, PA 19034-3413
- **Practice address phone:** (215) 643-0300
- **Practice address fax:** (215) 643-0333
- **Mailing address:** 428 PENNSYLVANIA AVE, FORT WASHINGTON, PA 19034-3413
- **Mailing address phone:** (215) 643-0300
- **Mailing address fax:** (215) 643-0333

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS037069 | PA | Yes |

## Other

- **Enumeration date:** 01/14/2015
- **Last updated:** 01/14/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 101930230 | — | PA |