Healthcare Provider Details

I. General information

NPI: 1225774151
Provider Name (Legal Business Name): ROBERT BIEDRON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 07/25/2022
Certification Date: 07/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 E WASHINGTON AVE
MADISON WI
53704-3236
US

IV. Provider business mailing address

4530 TURQUOISE LN
MADISON WI
53714-2533
US

V. Phone/Fax

Practice location:
  • Phone: 608-616-5897
  • Fax:
Mailing address:
  • Phone: 847-454-6825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6001034-15
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: