Provider Demographics
NPI:1114357951
Name:MANPREET S BADYAL
Entity Type:Organization
Organization Name:MANPREET S BADYAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:MANPREET
Authorized Official - Middle Name:S
Authorized Official - Last Name:BADYAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-906-9868
Mailing Address - Street 1:421 W HATCHER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-2455
Mailing Address - Country:US
Mailing Address - Phone:602-906-9868
Mailing Address - Fax:602-906-9864
Practice Address - Street 1:421 W HATCHER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2455
Practice Address - Country:US
Practice Address - Phone:602-906-9868
Practice Address - Fax:602-906-9864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5722122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========Medicaid