1275894297 NPI number — BADII ORTHODONTICS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275894297 NPI number — BADII ORTHODONTICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BADII ORTHODONTICS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BADII ORTODONTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275894297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 W STATE ST
Provider Second Line Business Mailing Address:
SUITE 4A
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92373-4653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-798-2755
Provider Business Mailing Address Fax Number:
909-307-2098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 W STATE ST
Provider Second Line Business Practice Location Address:
SUITE 4A
Provider Business Practice Location Address City Name:
REDLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92373-4653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-798-2755
Provider Business Practice Location Address Fax Number:
909-307-2098
Provider Enumeration Date:
06/06/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BADII
Authorized Official First Name:
KIAVASH
Authorized Official Middle Name:
KEVIN
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
909-798-2755

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  54538 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)