Basic Information
| Provider Information | |||||||||
| NPI: | 1174882062 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BADII DENTAL INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 NEWPORT BLVD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495485588 | ||||||||
| FaxNumber: | 9495485731 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 NEWPORT BLVD. | ||||||||
| Address2: | SUITE B | ||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495485588 | ||||||||
| FaxNumber: | 9495485731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2012 | ||||||||
| LastUpdateDate: | 03/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | BADII | ||||||||
| AuthorizedOfficialFirstName: | KIAVASH | ||||||||
| AuthorizedOfficialMiddleName: | KEVIN | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7148352383 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | 122300000X | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | 1223P0221X | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.