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General NPI Number Information
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NPI Number | 1730166919
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Entity Type | Individual
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Provider Name | MARTIN CLARE RADKE DDS
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 12/03/2010
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Provider Practice Location Address
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Address Line | 2151 SANTA CLARA AVE
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City | ALAMEDA
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State | CA
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Zip | 94501-2832
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Country | US
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Telephone | 510-599-9889
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Fax |
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Provider Business Mailing Address
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Address Line | 2151 SANTA CLARA AVE
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City | ALAMEDA
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State | CA
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Zip | 94501-2832
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Country | US
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Telephone | 510-599-9889
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 33142
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License Number State | CA
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