Provider Demographics
NPI:1417950411
Name:BADRIGIAN, ROBERT JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:BADRIGIAN
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 1:5 S MAIN ST
Mailing Address - Street 2:STE 515
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3846
Mailing Address - Country:US
Mailing Address - Phone:203-488-7799
Mailing Address - Fax:203-488-6899
Practice Address - Street 1:5 S MAIN ST
Practice Address - Street 2:STE 515
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3846
Practice Address - Country:US
Practice Address - Phone:203-488-7799
Practice Address - Fax:203-488-6899
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0075511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice