Provider Demographics
NPI:1508902198
Name:BADII, BONNIE MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:MICHELLE
Last Name:BADII
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 PORT CLARIDGE PL
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6612
Mailing Address - Country:US
Mailing Address - Phone:619-961-7456
Mailing Address - Fax:
Practice Address - Street 1:480 4TH AVE STE 314
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4403
Practice Address - Country:US
Practice Address - Phone:619-425-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice