Provider Demographics
NPI:1700917879
Name:PIDKOVA, ROMAN (DDS, APC)
Entity Type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:PIDKOVA
Suffix:
Gender:M
Credentials:DDS, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 VASSAR AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-4410
Mailing Address - Country:US
Mailing Address - Phone:818-347-0340
Mailing Address - Fax:818-347-1606
Practice Address - Street 1:7257 VASSAR AVE STE 100
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-4410
Practice Address - Country:US
Practice Address - Phone:818-347-0340
Practice Address - Fax:818-347-1606
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice