Healthcare Provider Details

I. General information

NPI: 1497819197
Provider Name (Legal Business Name): BRIAN P RADULOVICH DMD MSD INC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8247 COLUMBIA ROAD
OLMSTED FALLS OH
44138
US

IV. Provider business mailing address

8247 COLUMBIA ROAD
OLMSTED FALLS OH
44138
US

V. Phone/Fax

Practice location:
  • Phone: 440-235-1777
  • Fax: 440-235-5610
Mailing address:
  • Phone: 440-235-1777
  • Fax: 440-235-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number17493
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: