Provider Demographics
NPI:1669473120
Name:RADEL, ROBERT TIMOTHY (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TIMOTHY
Last Name:RADEL
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 A1A N
Mailing Address - Street 2:SUITE 314
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-3260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:822 A1A N
Practice Address - Street 2:SUITE 314
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-3260
Practice Address - Country:US
Practice Address - Phone:904-273-5770
Practice Address - Fax:904-273-5720
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40981223E0200X
PADS030989L1223E0200X
FLDN178871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics