Provider Demographics
NPI:1851447163
Name:ROBERT E. BRADLEY DDS & ROBERT J. ANGERAME DDS LTD
Entity Type:Organization
Organization Name:ROBERT E. BRADLEY DDS & ROBERT J. ANGERAME DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ANGERAME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-358-4090
Mailing Address - Street 1:124 E. PALATINE RD
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067
Mailing Address - Country:US
Mailing Address - Phone:847-358-4090
Mailing Address - Fax:847-358-4094
Practice Address - Street 1:124 E. PALATINE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067
Practice Address - Country:US
Practice Address - Phone:847-358-4090
Practice Address - Fax:847-358-4094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-27
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190177831223G0001X
IL0190133121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty