Randy Gordon Raetz, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

045887 Issued in NY

Practice address

2273 S Clinton Ave
Rochester, NY 14618-2662

Phone

(585) 473-1550

Fax

(585) 473-1552

NPI assigned

May 24, 2005

Last updated

Sep 2, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

State licenses

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314921600000",
    "number": "1811990807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2273 S CLINTON AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146182662",
            "telephone_number": "585-473-1550",
            "fax_number": "585-473-1552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2273 S CLINTON AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146182662",
            "telephone_number": "585-473-1550",
            "fax_number": "585-473-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAETZ",
        "first_name": "RANDY",
        "middle_name": "GORDON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2011-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "045887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Radiologists of Univ of Rochester
• Elizabeth Jordan Radley, LMSW
• Galina Semenovna Radunsky, DO
• Lisa Joanna Raetz, BSW,CASAC-T
• Olivia Marie Raetz, PA
• Thomas Nicholas Rafaill
• Jennifer Lynn Rafferty, PHARMD
• Christina Ann Rager, M.D.
• Dawn Raggio, CASAC
• Terri Ragin, PA

• General Practice Dentistry in Rochester, NY
• Providers in Rochester, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; 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.