Provider Demographics
NPI:1003827288
Name:RADU, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RADU
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 1:1865 NW BOCA RATON BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1638
Mailing Address - Country:US
Mailing Address - Phone:561-394-2668
Mailing Address - Fax:561-394-7880
Practice Address - Street 1:1865 NW BOCA RATON BLVD
Practice Address - Street 2:STE 101
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1638
Practice Address - Country:US
Practice Address - Phone:561-394-2668
Practice Address - Fax:561-394-7880
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist