Provider Demographics
NPI:1477927457
Name:RADEFELD, JACLYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:RADEFELD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6688 RIDGE RD
Mailing Address - Street 2:SUITE 1435
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5706
Mailing Address - Country:US
Mailing Address - Phone:440-884-1970
Mailing Address - Fax:440-884-3294
Practice Address - Street 1:6688 RIDGE RD
Practice Address - Street 2:SUITE 1435
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5706
Practice Address - Country:US
Practice Address - Phone:440-884-1970
Practice Address - Fax:440-884-3294
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0246371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice