Provider Demographics
NPI:1669569893
Name:PKR ENDODONTICS, P.C.
Entity type:Organization
Organization Name:PKR ENDODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:RADTKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-879-2300
Mailing Address - Street 1:8809 W 400 N
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9330
Mailing Address - Country:US
Mailing Address - Phone:219-879-2300
Mailing Address - Fax:219-879-6420
Practice Address - Street 1:8809 W 400 N
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9330
Practice Address - Country:US
Practice Address - Phone:219-879-2300
Practice Address - Fax:219-879-6420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009839A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty