MEDICARE: MR. BRADLEY STEPHEN ROBERTS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2108	NV

General Provider Information

NPI Number	:	1104063460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADLEY STEPHEN ROBERTS DDS

Provider Business Mailing Address
First Line	:	3047 E. WARM SPRINGS RD
Second Line	:	#200
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:	702-454-8773
Fax Number	:	702-454-8267

Provider Business Practice Location Address
First Line	:	3047 E. WARM SPRINGS ROAD
Second Line	:	#200
City	:	LAS VEGAS
State	:	NV
Zip	:	89120
Country	:	US
Telephone Number	:	702-454-8773
Fax Number	:	702-454-8267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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