Bradley Robertson, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3022 Issued in ID

Practice address

1212 N Cole Rd
Boise, ID 83704-8646

Phone

(208) 322-1747

Fax

(208) 322-1748

NPI assigned

Mar 26, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1568580074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2957 W COLONY CT",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836167201",
            "telephone_number": "208-938-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 N COLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048646",
            "telephone_number": "208-322-1747",
            "fax_number": "208-322-1748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA ID #",
            "identifier": "834079",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Makayla Roberts
• Megan Roberts, LPC
• Taylor Roberts, PA
• Amber Robertson, CPSS
• Anna Robertson, M.S.,CCC-SLP
• Jeremy Robertson
• Jordan Robertson, D.C.
• Kari Ann Robertson, D.C.
• Robinson Dental LLC
• Abbigail Robinson

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.