Provider Demographics
NPI:1205983277
Name:RADZ, ROBERT R (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:RADZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:R
Other - Last Name:RADZ
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11201 88TH AVE E
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3802
Mailing Address - Country:US
Mailing Address - Phone:253-848-2988
Mailing Address - Fax:253-840-9221
Practice Address - Street 1:11201 88TH AVE E
Practice Address - Street 2:SUITE 110
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3802
Practice Address - Country:US
Practice Address - Phone:253-848-2988
Practice Address - Fax:253-840-9221
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA81671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice