Provider Demographics
NPI:1972680767
Name:BARDIDEH BADR, NEGIN (DDS)
Entity Type:Individual
Prefix:
First Name:NEGIN
Middle Name:
Last Name:BARDIDEH BADR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12025 46TH DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-9657
Mailing Address - Country:US
Mailing Address - Phone:425-338-9546
Mailing Address - Fax:
Practice Address - Street 1:5920 EVERGREEN WAY STE E
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6005
Practice Address - Country:US
Practice Address - Phone:425-355-2330
Practice Address - Fax:425-355-2336
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000107211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice