Provider Demographics
NPI:1063813228
Name:AFFORDABLE DENTURES - BROOK PARK, BRIANW. REDDITT, DMD, INC.
Entity type:Organization
Organization Name:AFFORDABLE DENTURES - BROOK PARK, BRIANW. REDDITT, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:REDDITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-898-5812
Mailing Address - Street 1:5859 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2005
Mailing Address - Country:US
Mailing Address - Phone:216-898-5812
Mailing Address - Fax:216-898-5815
Practice Address - Street 1:5859 SMITH RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2005
Practice Address - Country:US
Practice Address - Phone:216-898-5812
Practice Address - Fax:216-898-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty