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Individual

MR. EDWARD STEPHEN RADIVONYK JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
637 MAIN STREET, FITCHBURG, MA 01420-3107
(978) 342-2222
(978) 342-1292
Mailing address
637 MAIN STREET, FITCHBURG, MA 01420-3107
(978) 342-2222
(978) 342-1292

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN16221
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0269441
MA
Enumeration date
12/29/2006
Last updated
07/08/2007
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