Provider Demographics
NPI:1770595746
Name:RODICH, TED (DDS)
Entity type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:RODICH
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 1:22400 S SALAMO RD
Mailing Address - Street 2:SUITE: 205
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-8269
Mailing Address - Country:US
Mailing Address - Phone:503-657-8787
Mailing Address - Fax:503-657-5522
Practice Address - Street 1:22400 S SALAMO RD
Practice Address - Street 2:SUITE: 205
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-8269
Practice Address - Country:US
Practice Address - Phone:503-657-8787
Practice Address - Fax:503-657-5522
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD78841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery