Provider Demographics
NPI:1558455980
Name:BARDILL, ROBERT C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:BARDILL
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 1:900 6TH STREET NORTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016
Mailing Address - Country:US
Mailing Address - Phone:715-386-5888
Mailing Address - Fax:715-386-1648
Practice Address - Street 1:900 6TH STREET NORTH
Practice Address - Street 2:SUITE 200
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016
Practice Address - Country:US
Practice Address - Phone:715-386-5888
Practice Address - Fax:715-386-1648
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001800G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice