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Individual
DR. TIMOTHY RUSSELL RADIN
Active
Individual
DR. TIMOTHY RUSSELL RADIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
044918
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
044918
STATE LICENSE
NY
Enumeration date
09/14/2012
Last updated
09/14/2012
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