Provider Demographics
NPI:1013171701
Name:RADLOSKY, BRAD (DMD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:
Last Name:RADLOSKY
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 1:10463 FOGGY GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1141
Mailing Address - Country:US
Mailing Address - Phone:954-270-9235
Mailing Address - Fax:
Practice Address - Street 1:10463 FOGGY GLEN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1141
Practice Address - Country:US
Practice Address - Phone:954-270-9235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS7-831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics