Provider Demographics
NPI:1275875197
Name:BADII LEE DENTAL CORPORATION, INC
Entity Type:Organization
Organization Name:BADII LEE DENTAL CORPORATION, INC
Other - Org Name:SMILE WIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIAVASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BADII
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-364-0590
Mailing Address - Street 1:777 CORPORATE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2135
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 CORPORATE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2135
Practice Address - Country:US
Practice Address - Phone:949-364-0590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty