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General NPI Number Information
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NPI Number | 1043361322
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Entity Type | Individual
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Provider Name | GARY MICHAEL RADZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 999 18TH ST #235
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City | DENVER
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State | CO
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Zip | 80202-2499
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Country | US
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Telephone | 303-298-1414
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Fax | 303-298-8437
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Provider Business Mailing Address
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Address Line | 11656 E BERRY DR
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City | ENGLEWOOD
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State | CO
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Zip | 80111-4146
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Country | US
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Telephone | 303-477-2378
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7955
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License Number State | CO
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