Provider Demographics
NPI:1003044025
Name:IYER, RADHIKA (DMD)
Entity Type:Individual
Prefix:DR
First Name:RADHIKA
Middle Name:
Last Name:IYER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W ROCHELLE RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-5348
Mailing Address - Country:US
Mailing Address - Phone:469-706-9355
Mailing Address - Fax:469-706-9344
Practice Address - Street 1:2020 W ROCHELLE RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5348
Practice Address - Country:US
Practice Address - Phone:469-706-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18551581223G0001X
TX276151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice