Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 30.019192 | OH |
NPI | 1043359391 |
---|---|
Provider Name | Dr. Frank George Radis |
First Address | Aurora, OH 44202-8739 |
Second Address | Aurora, OH 44202-8739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2050097 | (05) | OH |