Provider Demographics
NPI:1720200421
Name:IRADI, VICTOR JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:JOHN
Last Name:IRADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 ATLANTIC AVE
Mailing Address - Street 2:BLDG B SUITE 1
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-528-9799
Mailing Address - Fax:732-722-8344
Practice Address - Street 1:1903 ATLANTIC AVE STE 1
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1005
Practice Address - Country:US
Practice Address - Phone:732-528-9799
Practice Address - Fax:732-528-8597
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028324L1223P0700X
NJDI0184071223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics