Provider Demographics
NPI:1649315227
Name:RADKE, RYLE AUGUST III (DDS)
Entity type:Individual
Prefix:DR
First Name:RYLE
Middle Name:AUGUST
Last Name:RADKE
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:129 CARNEGIE WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709
Mailing Address - Country:US
Mailing Address - Phone:907-457-4480
Mailing Address - Fax:907-452-5865
Practice Address - Street 1:2136 AIRPORT WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-457-4480
Practice Address - Fax:907-452-3865
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA5491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0549Medicaid