Edward Stephen Radivonyk Jr., DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN16221 Issued in MA

Practice address

637 Main Street
Fitchburg, MA 01420-3107

Phone

(978) 342-2222

Fax

(978) 342-1292

NPI assigned

Dec 29, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336205699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "637 MAIN STREET",
            "city": "FITCHBURG",
            "state": "MA",
            "postal_code": "014203107",
            "telephone_number": "978-342-2222",
            "fax_number": "978-342-1292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "637 MAIN STREET",
            "city": "FITCHBURG",
            "state": "MA",
            "postal_code": "014203107",
            "telephone_number": "978-342-2222",
            "fax_number": "978-342-1292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADIVONYK",
        "first_name": "EDWARD",
        "middle_name": "STEPHEN",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN16221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0269441",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dariana Quinones
• Michael Patrick Quist
• Omar Rashid Qureshi, DO
• Ali Rad, D.M.D.
• Vasuki Radhakrishnan, M.D.
• Elida Rafael-Felker
• Francisco Rafael Ramos Jr.
• Gabriella Ramos
• Julia Ramos
• Yaritza L Ramos

• General Practice Dentistry in Fitchburg, MA
• Providers in Fitchburg, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.