Provider Demographics
NPI:1912180936
Name:BADA, MARCELO VILLALOBOS (DDS)
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:VILLALOBOS
Last Name:BADA
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 1:2 TICONDEROGA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2558
Mailing Address - Country:US
Mailing Address - Phone:951-273-2938
Mailing Address - Fax:
Practice Address - Street 1:2 TICONDEROGA
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-2558
Practice Address - Country:US
Practice Address - Phone:951-273-2938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA536931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice