Healthcare Provider Details

I. General information

NPI: 1730166919
Provider Name (Legal Business Name): MARTIN CLARE RADKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 SANTA CLARA AVE
ALAMEDA CA
94501-2832
US

IV. Provider business mailing address

2151 SANTA CLARA AVE
ALAMEDA CA
94501-2832
US

V. Phone/Fax

Practice location:
  • Phone: 510-599-9889
  • Fax:
Mailing address:
  • Phone: 510-599-9889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number33142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: