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General NPI Number Information
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NPI Number | 1902924822
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Entity Type | Individual
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Provider Name | FRANK GERARD RADTKE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 2128 W VIENNA RD
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City | CLIO
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State | MI
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Zip | 48420-2128
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Country | US
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Telephone | 810-686-8870
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Fax | 810-686-6833
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Provider Business Mailing Address
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Address Line | 2128 W VIENNA RD P. O. BOX 39
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City | CLIO
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State | MI
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Zip | 48420-2128
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Country | US
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Telephone | 810-686-8870
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Fax | 810-686-6833
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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 | D014782
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License Number State | MI
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