Provider Demographics
NPI:1487661310
Name:RADIN, LEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEN
Middle Name:
Last Name:RADIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:LEONARD
Other - Middle Name:
Other - Last Name:RADIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:99 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247
Mailing Address - Country:US
Mailing Address - Phone:413-662-2875
Mailing Address - Fax:
Practice Address - Street 1:99 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247
Practice Address - Country:US
Practice Address - Phone:413-662-2875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0229741Medicaid