Provider Demographics
NPI:1902983224
Name:RADDIN, HARRY JR (DDS,MSD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:RADDIN
Suffix:JR
Gender:M
Credentials:DDS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13841 HULL STREET RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2056
Mailing Address - Country:US
Mailing Address - Phone:804-739-0963
Mailing Address - Fax:804-739-0965
Practice Address - Street 1:13841 HULL STREET RD
Practice Address - Street 2:SUITE 4
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2056
Practice Address - Country:US
Practice Address - Phone:804-739-0963
Practice Address - Fax:804-739-0965
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010044751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics