Provider Demographics
NPI:1942423900
Name:SIUDARA, PETER W (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:W
Last Name:SIUDARA
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 1:1578 CALLE PORTADA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8420
Mailing Address - Country:US
Mailing Address - Phone:805-484-2405
Mailing Address - Fax:
Practice Address - Street 1:750 W GONZALES RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-9025
Practice Address - Country:US
Practice Address - Phone:805-983-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist