Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN11674 | FL |
NPI | 1003827288 |
---|---|
Provider Name | Dr. Michael Radu |
First Address | Boca Raton, FL 33432-1638 |
Second Address | Boca Raton, FL 33432-1638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 03/10/2007 |