Provider Demographics
NPI:1538333810
Name:BRADBERRY, ROBERT DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:BRADBERRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1070 WOODLAWN DR NE
Mailing Address - Street 2:STE 250
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4264
Mailing Address - Country:US
Mailing Address - Phone:770-077-8644
Mailing Address - Fax:770-971-7953
Practice Address - Street 1:1070 WOODLAWN DR NE
Practice Address - Street 2:STE 250
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4264
Practice Address - Country:US
Practice Address - Phone:770-077-8644
Practice Address - Fax:770-971-7953
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist