Provider Demographics
NPI:1891560280
Name:IADI, INC
Entity Type:Organization
Organization Name:IADI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, DMSC
Authorized Official - Phone:858-229-9869
Mailing Address - Street 1:440 S MELROSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6666
Mailing Address - Country:US
Mailing Address - Phone:858-229-9869
Mailing Address - Fax:
Practice Address - Street 1:440 S MELROSE DR STE 100
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6666
Practice Address - Country:US
Practice Address - Phone:858-229-9869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty