SU JIN BAE (NPI# 1962959320) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962959320 |
| Entity Type | Individual |
| Full Name | SU JIN BAE |
| Credential | DDS |
| Practice Address |
335 Prairie Ave Providence RI 02905-1924 |
| Mailing Address |
375 Allens Ave Providence RI 02905-5010 |
| Practice Telephone | 4014440430 |
| Practice Fax Number | 4014440489 |
| Mailing Telephone | 4014440400 |
| Mailing Fax Number | 4014440468 |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2017-10-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | DEN03358 | RI | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
11708 | CT | Dental Providers |
| Street Address |
335 PRAIRIE AVE |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02905-1924 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548318884 | Melissa A Weintraub | Dentist | 335 Prairie Ave, Providence, RI 02905-2426 | 2007-01-05 |
| 1891309225 | Ethan Melillo | Pharmacist | 335 Prairie Ave, Providence, RI 02905-1924 | 2020-09-02 |
| 1215549910 | Jackie Habchi | Pharmacist | 335 Prairie Ave, Providence, RI 02905-1924 | 2020-08-24 |
| 1073125274 | Zachary Allen Armstrong | Pharmacist | 335 Prairie Ave, Providence, RI 02905-1924 | 2020-08-19 |
| 1598380610 | Megan E Lusignan | Optometrist | 335 Prairie Ave, Providence, RI 02905-1924 | 2020-06-15 |
| 1518431006 | Tiffany F Rea | Registered Nurse | 335 Prairie Ave, Providence, RI 02905-1924 | 2019-01-17 |
| 1184118127 | Erica Ann Knarr | Dentist | 335 Prairie Ave, Providence, RI 02905 | 2018-06-21 |
| 1336675768 | Valerie Marie Vorderstrasse | Psychologist | 335 Prairie Ave, Providence, RI 02905-1924 | 2017-05-04 |
| 1215478219 | The Providence Community Health Centers, Inc. | Clinic/Center | 335 Prairie Ave, Providence, RI 02905-1924 | 2017-03-10 |
| 1942756549 | Sarah Elizabeth Skov | Pharmacist | 335 Prairie Ave, Providence, RI 02905 | 2016-09-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477100808 | Raisa Emilia Garcia-diaz | Counselor | 66 Pavilion Avenue, Providence, RI 02905 | 2019-08-21 |
| 1962976571 | Nike A. Kendall | Social Worker | Program In Women's Oncology, 101 Dudley Street, Providence, RI 02905 | 2019-01-16 |
| 1891265443 | Carolyn Te Young | Pathology | 1320 Narragansett Blvd, Cranston, RI 02905 | 2018-11-27 |
| 1417427071 | Julianne Elizabeth Houtchens | Dietitian, Registered | Adult Primary Care 245 Chapman Street, Providence, RI 02905 | 2018-11-27 |
| 1922577394 | Dilenia C Cruz | Health Educator | 335r Prairie Ave., Suite 2b, Providence, RI 02905 | 2018-11-15 |
| 1639653116 | Varina S. Gunn | Health Educator | 335r Prarie Ave., Suite 2b, Providence, RI 02905 | 2018-09-20 |
| 1427590421 | Cardea Healthcare LLC | In Home Supportive Care | 100 Pavilion Avenue, Suite 101, Providence, RI 02905 | 2016-11-08 |
| 1265884597 | Maxwell King | Physical Therapy Assistant | 48 Moorland Avenue, Cranston, RI 02905 | 2016-07-11 |
| 1346698024 | Samantha Lea Colli | Physician Assistant | 100 Dudley St Fl 3, Providence, RI 02905 | 2016-06-02 |
| 1346697448 | Amy Jean Simpson | Marriage & Family Therapist | 1981 Broad Street, Cranston, RI 02905 | 2016-05-18 |
| Find all providers in zip 02905 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033574975 | Redwood Dental | Dentist | 271 N Spring Creek Pkwy, Suite D, Providence, UT 84332-9875 | 2015-12-18 |
| 1336492149 | Carmel Absi | Dentist | 3 Regency Plz, Providence, RI 02903-3161 | 2012-10-17 |
| 1285981530 | Jordan Joseph Hansen | Dentist | 169 N Gateway Drive, Suite 200, Providence, UT 84332 | 2012-08-06 |
| 1972734515 | Celeste C Mortenson | Dentist | 169 N Gateway Dr Ste 175, Providence, UT 84332-9825 | 2009-07-30 |
| 1740499136 | Roger N Carlsten | Dentist | 433 Lloyd Ave, Providence, RI 02906 | 2007-05-22 |
| 1053530733 | Sunnyside Family Dental | Dentist | 381 Angell St, Providence, RI 02906-3214 | 2007-04-24 |
| 1205053899 | John R Ricci | Dentist | 1252 Smith St, Providence, RI 02908 | 2007-04-18 |
| 1720111503 | Diane T Monti Markowski | Dentist | 931 Smith Street, Providence, RI 02908 | 2007-03-13 |
| 1265560445 | Jacob Werba Werba | Dentist | 655 Broad St, Providence, RI 02907-1444 | 2007-03-01 |
| 1487717302 | Ernest P. Votolato | Dentist | 266 Wayland Ave, Providence, RI 02906-4524 | 2006-12-19 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 02905 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.