1053310730 NPI number — DR. RICHARD G. RAAD DDS

Table of content: DR. RICHARD G. RAAD DDS (NPI 1053310730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053310730 NPI number — DR. RICHARD G. RAAD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAAD
Provider First Name:
RICHARD
Provider Middle Name:
G.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053310730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50505 SCHOENHERR RD
Provider Second Line Business Mailing Address:
STE 170
Provider Business Mailing Address City Name:
SHELBY TOWNSHIP
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48315-3141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-530-0689
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41400 DEQUINDRE RD
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
STERLING HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48314-3763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-739-1111
Provider Business Practice Location Address Fax Number:
586-726-9441
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D13803 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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