Provider Demographics
NPI:1174686257
Name:SIDDALL, RODNEY F (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:F
Last Name:SIDDALL
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 1:150 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278
Mailing Address - Country:US
Mailing Address - Phone:330-633-4000
Mailing Address - Fax:330-633-8096
Practice Address - Street 1:150 WEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278
Practice Address - Country:US
Practice Address - Phone:330-633-4000
Practice Address - Fax:330-633-8096
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH168851223G0001X
CA297511223G0001X
FLDN97261223G0001X
AZ28671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice