Healthcare Provider Details

I. General information

NPI: 1629272356
Provider Name (Legal Business Name): DAVID RAD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 WISCONSIN AVE STE 500
BETHESDA MD
20814-4848
US

IV. Provider business mailing address

7201 WISCONSIN AVE STE 500
BETHESDA MD
20814-4848
US

V. Phone/Fax

Practice location:
  • Phone: 617-512-7119
  • Fax:
Mailing address:
  • Phone: 617-512-7119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14482
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: