Organization
BRADLEY W ROBERTS DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY WANE ROBERTS DMD (PRESIDENT)
(618) 465-9000
Entity
Organization
Contact information
Practice address
4 PROFESSIONAL DRIVE, ALTON, IL 62002
(618) 465-9000
Mailing address
4 PROFESSIONAL DRIVE, ALTON, IL 62002
(618) 465-9000
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
IL
Other
Enumeration date
01/22/2007
Last updated
08/22/2020
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