Provider Demographics
NPI:1386034247
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MBA
Authorized Official - Phone:949-596-8100
Mailing Address - Street 1:19762 MACARTHUR BLVD.
Mailing Address - Street 2:100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-7209
Mailing Address - Country:US
Mailing Address - Phone:949-596-8100
Mailing Address - Fax:562-424-9807
Practice Address - Street 1:2360 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-3051
Practice Address - Country:US
Practice Address - Phone:562-595-0731
Practice Address - Fax:562-595-6462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56861122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty