Provider Demographics
NPI:1154827210
Name:BONNIE M. BADII, D.D.S., DENTAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BONNIE M. BADII, D.D.S., DENTAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-994-6040
Mailing Address - Street 1:645 SAN ANTONIO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-3458
Mailing Address - Country:US
Mailing Address - Phone:619-994-6040
Mailing Address - Fax:
Practice Address - Street 1:480 4TH AVE STE 314
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4403
Practice Address - Country:US
Practice Address - Phone:619-425-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty