Provider Demographics
NPI:1871621946
Name:JOHN J. RADOMILE AND MARK G. RADOMILE PTR
Entity type:Organization
Organization Name:JOHN J. RADOMILE AND MARK G. RADOMILE PTR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RADOMILE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-123-4066
Mailing Address - Street 1:4207 STATE RD
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3321
Mailing Address - Country:US
Mailing Address - Phone:610-789-4066
Mailing Address - Fax:610-789-8507
Practice Address - Street 1:4207 STATE RD
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3321
Practice Address - Country:US
Practice Address - Phone:610-789-4066
Practice Address - Fax:610-789-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty