Provider Demographics
NPI:1023032687
Name:PENDELL, BRAD ALLEN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ALLEN
Last Name:PENDELL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 SHYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9749
Mailing Address - Country:US
Mailing Address - Phone:740-289-9708
Mailing Address - Fax:740-289-9716
Practice Address - Street 1:1862 SHYVILLE RD
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9749
Practice Address - Country:US
Practice Address - Phone:740-289-9708
Practice Address - Fax:740-289-9716
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300196891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2472953Medicaid