Lee Robert Raddatz, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

AZ1421 Issued in AZ

Practice address

1277 E Missouri Ave
110
Phoenix, AZ 85014-2915

Phone

(602) 248-8745

Fax

(602) 248-7939

NPI assigned

Jul 28, 2011

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oral Surgery LTD

  • Oral and Maxillofacial Surgery (Dentist)
  • Phoenix, AZ
  • NPI 1255421897
  NPD (past) Authorized official

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

{
    "created_epoch": "1311811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311811200000",
    "number": "1942588710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1277 E MISSOURI AVE",
            "address_2": "110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850142915",
            "telephone_number": "602-248-8745",
            "fax_number": "602-248-7939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1277 E MISSOURI AVE",
            "address_2": "110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850142915",
            "telephone_number": "602-248-8745",
            "fax_number": "602-248-7939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADDATZ",
        "first_name": "LEE",
        "middle_name": "ROBERT",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-07-28",
        "last_updated": "2011-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "AZ1421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Katherine Radan
• Andrew Radau, MSN, AGACNP-BC
• Amanda Lynn Radcliffe, DNP
• Ivy K. Radcliffe, APRN
• Michael J. Radcliffe, DMD
• Haley Rader, ATC
• Kristine Lynette Rader, RN
• Meghan Marie Rader, CRNA
• Peggy J Radford, M.D.
• Priya Radhakrishnan, M.D.

• Oral and Maxillofacial Surgery (Dentist) in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.