Provider Demographics
NPI:1619411329
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
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:92612-2424
Mailing Address - Country:US
Mailing Address - Phone:949-596-8100
Mailing Address - Fax:562-424-9807
Practice Address - Street 1:172 E CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2702
Practice Address - Country:US
Practice Address - Phone:310-618-1522
Practice Address - Fax:310-618-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA568611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty