Provider Demographics
NPI:1750841862
Name:BADRI, BABAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BABAK
Middle Name:
Last Name:BADRI
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 1:503 MUIR ST STE A
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1848
Mailing Address - Country:US
Mailing Address - Phone:410-228-9381
Mailing Address - Fax:883-916-1011
Practice Address - Street 1:503 MUIR ST STE A
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1848
Practice Address - Country:US
Practice Address - Phone:410-228-9381
Practice Address - Fax:883-916-1011
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL8501223G0001X
MD173011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid