Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | S7-83 | NV |
NPI | 1013171701 |
---|---|
Provider Name | Brad Radlosky |
First Address | Las Vegas, NV 89135-1141 |
Second Address | Las Vegas, NV 89135-1141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2008 |
Last Update Date | 07/10/2015 |