Provider Demographics
NPI:1124414800
Name:CASS A. RADECKI, D.D.S., P.C.
Entity Type:Organization
Organization Name:CASS A. RADECKI, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RADECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-429-1384
Mailing Address - Street 1:203 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1329
Mailing Address - Country:US
Mailing Address - Phone:734-429-1384
Mailing Address - Fax:
Practice Address - Street 1:203 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1329
Practice Address - Country:US
Practice Address - Phone:734-429-1384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014771261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery