Provider Demographics
NPI:1417286303
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:KIAVASH
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BADII
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-835-2383
Mailing Address - Street 1:22330 HAWTHORNE BLVD.
Mailing Address - Street 2:SUITE 2016
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-375-5801
Mailing Address - Fax:310-375-6071
Practice Address - Street 1:22330 HAWTHORNE BLVD.
Practice Address - Street 2:SUITE 2016
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-375-5801
Practice Address - Fax:310-375-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223P0221X, 1223X0400X
CA545381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty