Provider Demographics
NPI:1093853129
Name:ROBERT R. RADZ DDS, PS.
Entity Type:Organization
Organization Name:ROBERT R. RADZ DDS, PS.
Other - Org Name:SOUTH HILL FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:RADZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-848-2988
Mailing Address - Street 1:10217 123RD STREET CT E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2633
Mailing Address - Country:US
Mailing Address - Phone:253-848-2988
Mailing Address - Fax:253-840-9221
Practice Address - Street 1:10217 123RD STREET CT E
Practice Address - Street 2:SUITE 100
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2633
Practice Address - Country:US
Practice Address - Phone:253-848-2988
Practice Address - Fax:253-840-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA81671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1205983277OtherINDIVIDUAL NPI