Provider Demographics
NPI:1164978227
Name:WILLIAM RADFORD JR DDS PLLC
Entity Type:Organization
Organization Name:WILLIAM RADFORD JR DDS PLLC
Other - Org Name:RADFORD FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HUBERT
Authorized Official - Last Name:RADFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-210-7769
Mailing Address - Street 1:1550 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2202
Mailing Address - Country:US
Mailing Address - Phone:336-258-2745
Mailing Address - Fax:336-258-2746
Practice Address - Street 1:1550 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2202
Practice Address - Country:US
Practice Address - Phone:336-258-2745
Practice Address - Fax:336-258-2746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty