Provider Demographics
NPI:1982132049
Name:RADZIKOWSKI, NATALIA ALICIA (DDS)
Entity Type:Individual
Prefix:
First Name:NATALIA
Middle Name:ALICIA
Last Name:RADZIKOWSKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 BOOT LN SE
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316-9062
Mailing Address - Country:US
Mailing Address - Phone:616-885-8713
Mailing Address - Fax:
Practice Address - Street 1:205 GROVE ST
Practice Address - Street 2:
Practice Address - City:MANCELONA
Practice Address - State:MI
Practice Address - Zip Code:49659-8018
Practice Address - Country:US
Practice Address - Phone:231-587-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist