Individual
DR. BRADLEY ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1212 N COLE RD, BOISE, ID 83704-8646
(208) 322-1747
(208) 322-1748
Mailing address
2957 W COLONY CT, EAGLE, ID 83616-7201
(208) 938-3520
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3022
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
834079
UNITED CONCORDIA ID #
ID
Enumeration date
03/26/2007
Last updated
07/08/2007
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