Provider Demographics
NPI:1326153438
Name:RADFORD, GARRY H JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARRY
Middle Name:H
Last Name:RADFORD
Suffix:JR
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 1:3216 OAKMONT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1131
Mailing Address - Country:US
Mailing Address - Phone:832-723-5052
Mailing Address - Fax:832-553-7724
Practice Address - Street 1:1317 W DAVIS ST STE D
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2334
Practice Address - Country:US
Practice Address - Phone:936-760-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76131223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120762303Medicaid