Provider Demographics
NPI:1164579280
Name:SIODA, FRANK KEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:KEN
Last Name:SIODA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18676 WILLAMETTE DR
Mailing Address - Street 2:SUITE #202
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-1718
Mailing Address - Country:US
Mailing Address - Phone:503-635-4509
Mailing Address - Fax:503-635-4852
Practice Address - Street 1:18676 WILLAMETTE DR
Practice Address - Street 2:SUITE #202
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-1718
Practice Address - Country:US
Practice Address - Phone:503-635-4509
Practice Address - Fax:503-635-4852
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD88531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice