Provider Demographics
NPI:1912259557
Name:RADABAUGH, CARIE ANN (RDH)
Entity Type:Individual
Prefix:
First Name:CARIE
Middle Name:ANN
Last Name:RADABAUGH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7955 E MINNESUING ACRES DR
Mailing Address - Street 2:
Mailing Address - City:LAKE NEBAGAMON
Mailing Address - State:WI
Mailing Address - Zip Code:54849-9067
Mailing Address - Country:US
Mailing Address - Phone:715-374-2574
Mailing Address - Fax:
Practice Address - Street 1:1313 FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-4600
Practice Address - Country:US
Practice Address - Phone:218-206-4328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10057-16124Q00000X
MNH7750124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist