Provider Demographics
NPI:1205197423
Name:REDDITT, BRIAN WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WILLIAM
Last Name:REDDITT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-2005
Mailing Address - Country:US
Mailing Address - Phone:216-898-5812
Mailing Address - Fax:216-898-5815
Practice Address - Street 1:5859 SMITH RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-2005
Practice Address - Country:US
Practice Address - Phone:216-898-5812
Practice Address - Fax:216-898-5815
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist