Provider Demographics
NPI:1043361322
Name:RADZ, GARY MICHAEL (DDS)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:MICHAEL
Last Name:RADZ
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 1:11656 E BERRY DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4146
Mailing Address - Country:US
Mailing Address - Phone:303-477-2378
Mailing Address - Fax:
Practice Address - Street 1:999 18TH ST
Practice Address - Street 2:#235
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-2499
Practice Address - Country:US
Practice Address - Phone:303-298-1414
Practice Address - Fax:303-298-8437
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO79551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice