Provider Demographics
NPI:1326158544
Name:SEDIVY, JOSEF (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEF
Middle Name:
Last Name:SEDIVY
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 1:10305 NE HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3954
Mailing Address - Country:US
Mailing Address - Phone:503-252-0048
Mailing Address - Fax:503-256-4041
Practice Address - Street 1:10305 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3954
Practice Address - Country:US
Practice Address - Phone:503-252-0048
Practice Address - Fax:503-256-4041
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD73551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice