Healthcare Provider Details

I. General information

NPI: 1316749377
Provider Name (Legal Business Name): MR. NATHANIEL EMERSON BRETZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 MENTOR AVE
MENTOR OH
44060-5411
US

IV. Provider business mailing address

3359 SPARROW FLIGHT DR
SEVEN HILLS OH
44131-5950
US

V. Phone/Fax

Practice location:
  • Phone: 440-975-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.027933
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: