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General NPI Number Information
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NPI Number | 1124414800
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Entity Type | Organization
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Legal Business Name | CASS A. RADECKI, D.D.S., P.C.
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 04/09/2015
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Provider Practice Location Address
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Address Line | 203 W MICHIGAN AVE
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City | SALINE
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State | MI
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Zip | 48176-1329
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Country | US
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Telephone | 734-429-1384
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Fax |
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Provider Business Mailing Address
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Address Line | 203 W MICHIGAN AVE
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City | SALINE
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State | MI
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Zip | 48176-1329
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Country | US
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Telephone | 734-429-1384
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CASS ANTHONY RADECKI
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Credential | D.D.S.
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Telephone | 734-429-1384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 2901014771
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License Number State | MI
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