Provider Demographics
NPI:1144792102
Name:AL BADRI, BASHAR (DDS)
Entity Type:Individual
Prefix:
First Name:BASHAR
Middle Name:
Last Name:AL BADRI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 HIGHLANDS WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6729
Mailing Address - Country:US
Mailing Address - Phone:202-361-5240
Mailing Address - Fax:
Practice Address - Street 1:3002 HIGHLANDS WAY
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-6729
Practice Address - Country:US
Practice Address - Phone:202-361-5240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist