1770798555 NPI number — FAINA M. BADINEVA DDS

Table of content: (NPI 1770798555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770798555 NPI number — FAINA M. BADINEVA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAINA M. BADINEVA DDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ESTHETIQUE DENTAL GROUP PC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770798555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1518 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19102-3419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-772-0707
Provider Business Mailing Address Fax Number:
215-772-0271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1518 WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19102-3419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-772-0707
Provider Business Practice Location Address Fax Number:
215-772-0271
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BADINEVA
Authorized Official First Name:
FAINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-772-0707

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DS031415L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1381013 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 223002 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com