Provider Demographics
NPI:1881688109
Name:BADER, MEDHAT G (DDS)
Entity Type:Individual
Prefix:DR
First Name:MEDHAT
Middle Name:G
Last Name:BADER
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:PSC 94 BOX 034
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824
Mailing Address - Country:TR
Mailing Address - Phone:01190322-316-3380
Mailing Address - Fax:
Practice Address - Street 1:39TH MEDICAL SQUADRON
Practice Address - Street 2:UNIT 7095 BOX 185
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09824
Practice Address - Country:TR
Practice Address - Phone:01190322-616-3380
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA194031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice