Healthcare Provider Details

I. General information

NPI: 1023032687
Provider Name (Legal Business Name): BRAD ALLEN PENDELL D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1862 SHYVILLE RD
PIKETON OH
45661-9749
US

IV. Provider business mailing address

1862 SHYVILLE RD
PIKETON OH
45661-9749
US

V. Phone/Fax

Practice location:
  • Phone: 740-289-9708
  • Fax: 740-289-9716
Mailing address:
  • Phone: 740-289-9708
  • Fax: 740-289-9716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30019689
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: