Provider Demographics
NPI:1770798555
Name:FAINA M. BADINEVA DDS
Entity type:Organization
Organization Name:FAINA M. BADINEVA DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BADINEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-772-0707
Mailing Address - Street 1:1518 WALNUT ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3419
Mailing Address - Country:US
Mailing Address - Phone:215-772-0707
Mailing Address - Fax:215-772-0271
Practice Address - Street 1:1518 WALNUT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3419
Practice Address - Country:US
Practice Address - Phone:215-772-0707
Practice Address - Fax:215-772-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031415L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1381013OtherUNITED CONCORDIA
UT223002OtherUNITED HEALTHCARE