Individual
DR. GIDEON PRASANTH KODALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
15715 NW CENTRAL DR STE 7, PORTLAND, OR 97229-1267
(503) 610-4038
Mailing address
6334 SE IMAGINE WAY, HILLSBORO, OR 97123-5059
(270) 363-5624
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11813
OR
Other
Enumeration date
07/07/2023
Last updated
07/07/2023
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