Radivonyk, Edward Stephen
Radivonyk, Edward Stephen is an individual health care provider with primary practice located at 637 Main Street , Fitchburg MA 01420-3107. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Radivonyk, Edward Stephen can be contacted via phone (978) 342-2222.Contact Information
Primary practice address
637 Main Street
Fitchburg MA 01420-3107
Phone: (978) 342-2222
Fax: (978) 342-1292
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | DN16221 | Massachusetts |
Profile Details
| NPI number | 1336205699 |
|---|---|
| LBN Legal business name | Radivonyk, Edward Stephen |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 29th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336205699 | NPPES |
| Massachusetts | MEDICAID | 0269441 |
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