Provider Demographics
NPI:1912179201
Name:KENDALL R. LIDAY DDS LLC
Entity Type:Organization
Organization Name:KENDALL R. LIDAY DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:R
Authorized Official - Last Name:LIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-543-4949
Mailing Address - Street 1:33640 E COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-3425
Mailing Address - Country:US
Mailing Address - Phone:503-543-4949
Mailing Address - Fax:503-543-7152
Practice Address - Street 1:33640 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056-3425
Practice Address - Country:US
Practice Address - Phone:503-543-4949
Practice Address - Fax:503-543-7152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD84581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty