1093853129 NPI number — ROBERT R. RADZ DDS, PS.

Table of content: (NPI 1093853129)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093853129 NPI number — ROBERT R. RADZ DDS, PS.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT R. RADZ DDS, PS.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1093853129
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10217 123RD STREET CT E
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98374-2633
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-848-2988
Provider Business Mailing Address Fax Number:
253-840-9221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10217 123RD STREET CT E
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98374-2633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-848-2988
Provider Business Practice Location Address Fax Number:
253-840-9221
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RADZ
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
253-848-2988

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  8167 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1205983277 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com