Individual
DR. BRADLEY WANE ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4 PROFESSIONAL DR, ALTON, IL 62002-5067
(618) 465-9000
Mailing address
4 PROFESSIONAL DR, ALTON, IL 62002-5067
(618) 465-9000
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
019019769
IL
Other
Enumeration date
05/21/2010
Last updated
05/21/2010
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