Organization
ICON DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT Z BADALOV DDS (OWNER)
(623) 432-0700
Entity
Organization
Contact information
Practice address
7435 W LOWER BUCKEYE RD, PHOENIX, AZ 85043-7636
(623) 432-0700
(866) 892-0774
Mailing address
7435 W LOWER BUCKEYE RD, PHOENIX, AZ 85043-7636
(623) 432-0700
(866) 892-0774
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D05930
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235163270
TYPE 1 NPI
AZ
Enumeration date
10/05/2017
Last updated
10/05/2017
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