Individual
GEON BAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
3340 PROVIDENCE DR STE 552, ANCHORAGE, AK 99508
(907) 336-1234
(907) 336-4321
Mailing address
3470 E MERIDIAN PARK LOOP, WASILLA, AK 99654-7294
(907) 373-8684
(907) 373-8465
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
139529
AK
1223P0221X
Pediatric Dentistry
Primary
139529
AK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/09/2016
Last updated
05/17/2021
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