# ICON DENTAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245740182
- **Authorized official:** DR. ROBERT Z BADALOV DDS (OWNER)
- **Authorized official phone:** (623) 432-0700

## Contact information

- **Practice address:** 7435 W LOWER BUCKEYE RD, PHOENIX, AZ 85043-7636
- **Practice address phone:** (623) 432-0700
- **Practice address fax:** (866) 892-0774
- **Mailing address:** 7435 W LOWER BUCKEYE RD, PHOENIX, AZ 85043-7636
- **Mailing address phone:** (623) 432-0700
- **Mailing address fax:** (866) 892-0774

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D05930 | AZ | Yes |

## Other

- **Enumeration date:** 10/05/2017
- **Last updated:** 10/05/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1235163270 | TYPE 1 NPI | AZ |