Provider Demographics
NPI:1386088136
Name:ROBINSON, BRADLEY J (DMD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:168 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7472
Mailing Address - Country:US
Mailing Address - Phone:623-695-2284
Mailing Address - Fax:
Practice Address - Street 1:3470 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7294
Practice Address - Country:US
Practice Address - Phone:907-373-8684
Practice Address - Fax:907-373-8465
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1203931223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty