Provider Demographics
NPI:1649438169
Name:BADALAMENTI, PETER JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:BADALAMENTI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8504 DEL WEBB BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-8676
Mailing Address - Country:US
Mailing Address - Phone:702-360-8696
Mailing Address - Fax:
Practice Address - Street 1:8504 DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8676
Practice Address - Country:US
Practice Address - Phone:702-360-8696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39411223G0001X
NV6498122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice