=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497084263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BADII ORTHODONTICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2009
-----------------------------------------------------
Last Update Date | 12/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1007 W LA PALMA AVE SUITE 2
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92801-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-635-9390
-----------------------------------------------------
Fax | 714-635-9014
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1007 W LA PALMA AVE SUITE 2
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92801-3620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-635-9390
-----------------------------------------------------
Fax | 714-635-9014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | BONNIE BADII
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-635-9390
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 54538
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------