Provider Demographics
NPI:1215497979
Name:ALBERTSON, BRADLEY ROBERT (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:ROBERT
Last Name:ALBERTSON
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2973 HALCYON DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3987
Mailing Address - Country:US
Mailing Address - Phone:563-349-9708
Mailing Address - Fax:
Practice Address - Street 1:4410 E RIVERSIDE DR STE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-4759
Practice Address - Country:US
Practice Address - Phone:512-385-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX347881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics