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General NPI Number Information
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NPI Number | 1710251764
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Entity Type | Organization
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Legal Business Name | BADII LEE DENTAL CORPORATION, INC
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Dates
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Enumeration Date | 03/07/2012
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 4980 BARRANCA PKWY SUITE 101
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City | IRVINE
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State | CA
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Zip | 92604-8645
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Country | US
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Telephone | 949-733-3433
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Fax | 949-733-3437
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Provider Business Mailing Address
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Address Line | 4980 BARRANCA PKWY SUITE 101
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City | IRVINE
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State | CA
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Zip | 92604-8645
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Country | US
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Telephone | 949-733-3433
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Fax | 949-733-3437
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Authorized Official
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Title or Position | PRESIDENT
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Name | KIAVASH KEVIN BADII
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Credential | DDS
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Telephone | 714-835-2383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 56861
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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