Provider Demographics
NPI:1245362227
Name:RABAL, BRADLEY STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:STEPHEN
Last Name:RABAL
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 1:3609 PARK EAST DR
Mailing Address - Street 2:SUITE # 514
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4331
Mailing Address - Country:US
Mailing Address - Phone:216-593-8000
Mailing Address - Fax:216-593-0228
Practice Address - Street 1:3609 PARK EAST DR
Practice Address - Street 2:SUITE # 514
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4331
Practice Address - Country:US
Practice Address - Phone:216-593-8000
Practice Address - Fax:216-593-0228
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-174061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice