Provider Demographics
NPI:1114093457
Name:SADAKAH, DANNY A (DMD)
Entity type:Individual
Prefix:DR
First Name:DANNY
Middle Name:A
Last Name:SADAKAH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9393 SE QUAIL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-9175
Mailing Address - Country:US
Mailing Address - Phone:503-869-4539
Mailing Address - Fax:
Practice Address - Street 1:18773 SW MARTINAZZI AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7458
Practice Address - Country:US
Practice Address - Phone:503-869-4539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist