Bradley Scott Roberts, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

16479 Issued in OH

Practice address

5855 West Utopia Rd
Midwestern University College of Dental Medicine
Glendale, AZ 85308

Phone

(623) 806-7011

Fax

(623) 806-7010

NPI assigned

May 29, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 25, 2017 through May 25, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Midwestern University

  • Dental Clinic/Center
  • Glendale, AZ
  • NPI 1164744009
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1245431428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 WEST UTOPIA RD",
            "address_2": "MIDWESTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-806-7011",
            "fax_number": "623-806-7010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5855 WEST UTOPIA RD",
            "address_2": "MIDWESTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85308",
            "telephone_number": "623-806-7011",
            "fax_number": "623-806-7010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "BRADLEY",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-29",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "16479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betsy Robello, LMT
• Idris Roberson
• Robert a. Block PHD PC
• Robert L. Critchfield DDS PC
• Robert Rubenzik, MDPC
• Cory Roberts, LPC
• Ellen Karen Roberts, MNS SLP
• Eugenia Popescu Roberts, DDS
• Nicole Alicia Roberts, PH.D.
• Rebecca Sue Roberts, PTA

• General Practice Dentistry in Glendale, AZ
• Providers in Glendale, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.