Provider Demographics
NPI:1417203480
Name:KANAR, BRENT
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:KANAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 CEDAR HEIGHTS DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635
Mailing Address - Country:US
Mailing Address - Phone:814-935-0251
Mailing Address - Fax:724-794-2225
Practice Address - Street 1:234 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057
Practice Address - Country:US
Practice Address - Phone:724-794-2224
Practice Address - Fax:724-794-2225
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist