Provider Demographics
NPI:1912268939
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:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIAVASH
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BADII
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MDS
Authorized Official - Phone:949-548-5588
Mailing Address - Street 1:1109 W 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3505
Mailing Address - Country:US
Mailing Address - Phone:714-835-2383
Mailing Address - Fax:714-835-3917
Practice Address - Street 1:1109 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3505
Practice Address - Country:US
Practice Address - Phone:714-835-2383
Practice Address - Fax:714-835-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty