Healthcare Provider Details

I. General information

NPI: 1114093457
Provider Name (Legal Business Name): DANNY A SADAKAH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18773 SW MARTINAZZI AVE
TUALATIN OR
97062-7458
US

IV. Provider business mailing address

9393 SE QUAIL RIDGE CT
PORTLAND OR
97266-9175
US

V. Phone/Fax

Practice location:
  • Phone: 503-869-4539
  • Fax:
Mailing address:
  • Phone: 503-869-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD8684
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: