Provider Demographics
NPI:1578889846
Name:KMENTT, BRADLEY A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:KMENTT
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 1:8484 MARKET ST # 1
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4100
Mailing Address - Country:US
Mailing Address - Phone:440-205-7500
Mailing Address - Fax:440-255-3204
Practice Address - Street 1:8484 MARKET ST # 1
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4100
Practice Address - Country:US
Practice Address - Phone:440-205-7500
Practice Address - Fax:440-255-3204
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH186641223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics