Provider Demographics
NPI:1275894297
Name:BADII ORTHODONTICS, INC.
Entity Type:Organization
Organization Name:BADII ORTHODONTICS, INC.
Other - Org Name:BADII ORTODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIAVASH
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BADII
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MDS
Authorized Official - Phone:909-798-2755
Mailing Address - Street 1:308 W STATE ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4653
Mailing Address - Country:US
Mailing Address - Phone:909-798-2755
Mailing Address - Fax:909-307-2098
Practice Address - Street 1:308 W STATE ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4653
Practice Address - Country:US
Practice Address - Phone:909-798-2755
Practice Address - Fax:909-307-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty