Provider Demographics
NPI:1699889139
Name:BADRI, FOROUZ (DDS)
Entity type:Individual
Prefix:
First Name:FOROUZ
Middle Name:
Last Name:BADRI
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 1:11819 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6619
Mailing Address - Country:US
Mailing Address - Phone:310-914-9246
Mailing Address - Fax:
Practice Address - Street 1:11819 WILSHIRE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6619
Practice Address - Country:US
Practice Address - Phone:310-914-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice