Provider Demographics
NPI:1982757100
Name:VIDJAK, FRANK MARIO ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:MARIO ANTONIO
Last Name:VIDJAK
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 1:465 N ROXBURY DR
Mailing Address - Street 2:SUITE # 703
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4206
Mailing Address - Country:US
Mailing Address - Phone:310-248-2786
Mailing Address - Fax:310-248-2886
Practice Address - Street 1:465 N ROXBURY DR
Practice Address - Street 2:SUITE # 703
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4206
Practice Address - Country:US
Practice Address - Phone:310-248-2786
Practice Address - Fax:310-248-2886
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333971223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics