Provider Demographics
NPI:1841308202
Name:RADCLIFFE, DENNIS L (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:L
Last Name:RADCLIFFE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 BACCURATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8702
Mailing Address - Country:US
Mailing Address - Phone:770-650-8389
Mailing Address - Fax:770-591-3365
Practice Address - Street 1:120 N MEDICAL PKWY
Practice Address - Street 2:BUILDING 200, SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-7062
Practice Address - Country:US
Practice Address - Phone:770-591-7929
Practice Address - Fax:770-591-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDN0118001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice