Provider Demographics
NPI:1780020966
Name:BADR, FOUAD (DMD)
Entity Type:Individual
Prefix:MR
First Name:FOUAD
Middle Name:
Last Name:BADR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 CLEVELAND AVE N
Mailing Address - Street 2:
Mailing Address - City:ARDEN HILLS
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:612-624-6644
Mailing Address - Fax:612-626-2655
Practice Address - Street 1:3130 CLEVELAND AVE N
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112
Practice Address - Country:US
Practice Address - Phone:612-624-6644
Practice Address - Fax:612-626-2655
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2019-10-28
Deactivation Date:2014-03-31
Deactivation Code:
Reactivation Date:2015-12-15
Provider Licenses
StateLicense IDTaxonomies
MNR553122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist