Provider Demographics
NPI:1477851251
Name:HUDEC DENTAL CENTER OF MENTOR, INC.
Entity Type:Organization
Organization Name:HUDEC DENTAL CENTER OF MENTOR, INC.
Other - Org Name:HUDEC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUDEC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-485-5788
Mailing Address - Street 1:3327 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3360
Mailing Address - Country:US
Mailing Address - Phone:216-485-5788
Mailing Address - Fax:216-485-1257
Practice Address - Street 1:7697 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5540
Practice Address - Country:US
Practice Address - Phone:440-530-3500
Practice Address - Fax:440-530-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0152651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3126003Medicaid