Provider Demographics
NPI:1164441465
Name:ALBERTELLI, ROBERT WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WILLIAM
Last Name:ALBERTELLI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6237
Mailing Address - Country:US
Mailing Address - Phone:801-295-7171
Mailing Address - Fax:801-295-7283
Practice Address - Street 1:319 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6237
Practice Address - Country:US
Practice Address - Phone:801-295-7171
Practice Address - Fax:801-295-7283
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4964666-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice