Healthcare Provider Details

I. General information

NPI: 1386088136
Provider Name (Legal Business Name): BRADLEY J. ROBINSON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 09/25/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 E MERIDIAN PARK LOOP
WASILLA AK
99654-7294
US

IV. Provider business mailing address

168 WESTVIEW DR
OREM UT
84058-7472
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-8684
  • Fax: 907-373-8465
Mailing address:
  • Phone: 623-695-2284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number120393
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: