Provider Demographics
NPI:1730166919
Name:RADKE, MARTIN CLARE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:CLARE
Last Name:RADKE
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 1:2151 SANTA CLARA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2832
Mailing Address - Country:US
Mailing Address - Phone:510-599-9889
Mailing Address - Fax:
Practice Address - Street 1:2151 SANTA CLARA AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-2832
Practice Address - Country:US
Practice Address - Phone:510-599-9889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331421223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics