Individual
EDWIN PAUL RADTKE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
907 NW 18TH AVE, PORTLAND, OR 97209
(503) 223-5110
(503) 223-5111
Mailing address
907 NW 18TH AVE, PORTLAND, OR 97209
(503) 223-5110
(503) 223-5111
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4862
OR
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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