Provider Demographics
NPI:1386619047
Name:RADECKI, JAMES M (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:RADECKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 W BRANDON BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4813
Mailing Address - Country:US
Mailing Address - Phone:813-685-7353
Mailing Address - Fax:813-681-5457
Practice Address - Street 1:1931 W BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4813
Practice Address - Country:US
Practice Address - Phone:813-685-7353
Practice Address - Fax:813-681-5457
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL108251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice