Healthcare Provider Details

I. General information

NPI: 1174882062
Provider Name (Legal Business Name): BADII DENTAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 NEWPORT BLVD. SUITE B
COSTA MESA CA
92627
US

IV. Provider business mailing address

1801 NEWPORT BLVD SUITE B
COSTA MESA CA
92627
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-5588
  • Fax: 949-548-5731
Mailing address:
  • Phone: 949-548-5588
  • Fax: 949-548-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KIAVASH KEVIN BADII
Title or Position: DIRECTOR/OWNER
Credential: DDS
Phone: 714-835-2383