Provider Demographics
NPI:1902179658
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:KIAVASH
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BADII
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-835-2383
Mailing Address - Street 1:11351 183RD ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5434
Mailing Address - Country:US
Mailing Address - Phone:562-402-9299
Mailing Address - Fax:
Practice Address - Street 1:11351 183RD ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5434
Practice Address - Country:US
Practice Address - Phone:562-402-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty