Provider Demographics
NPI:1063401172
Name:MONACO & BADIHI DDS PC
Entity type:Organization
Organization Name:MONACO & BADIHI DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:BADIHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-739-7900
Mailing Address - Street 1:500 NORTHWEST PLZ
Mailing Address - Street 2:SUITE 524
Mailing Address - City:SAINT ANN
Mailing Address - State:MO
Mailing Address - Zip Code:63074-2209
Mailing Address - Country:US
Mailing Address - Phone:314-739-7900
Mailing Address - Fax:
Practice Address - Street 1:500 NORTHWEST PLZ
Practice Address - Street 2:SUITE 524
Practice Address - City:SAINT ANN
Practice Address - State:MO
Practice Address - Zip Code:63074-2209
Practice Address - Country:US
Practice Address - Phone:314-739-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0153561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO407813310Medicaid