Provider Demographics
NPI:1114030335
Name:LAMOREUX, KENT STUART (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:STUART
Last Name:LAMOREUX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 ROCKSID RD.
Mailing Address - Street 2:212
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2749
Mailing Address - Country:US
Mailing Address - Phone:216-749-1242
Mailing Address - Fax:216-661-5553
Practice Address - Street 1:1440 ROCKSIDE RD
Practice Address - Street 2:212
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2774
Practice Address - Country:US
Practice Address - Phone:216-749-1242
Practice Address - Fax:216-661-5553
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30. 0144431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0328532Medicaid