Provider Demographics
NPI:1700877800
Name:RADLER, MARK L (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:RADLER
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:209 MARSHALL LANE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314
Mailing Address - Country:US
Mailing Address - Phone:732-890-3380
Mailing Address - Fax:757-238-2365
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:MONMOUTH MEDICAL CENTER
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740
Practice Address - Country:US
Practice Address - Phone:732-923-6585
Practice Address - Fax:732-923-6588
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-30
Last Update Date:2008-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJDI008413011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1851608Medicaid