Provider Demographics
NPI:1184782252
Name:ROBERT N OBRADOVICH DMD LLC
Entity type:Organization
Organization Name:ROBERT N OBRADOVICH DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:NICKOLAS
Authorized Official - Last Name:OBRADOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-727-3471
Mailing Address - Street 1:4430 RT 66
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613
Mailing Address - Country:US
Mailing Address - Phone:724-727-3471
Mailing Address - Fax:724-727-2316
Practice Address - Street 1:4430 RT 66
Practice Address - Street 2:
Practice Address - City:APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15613
Practice Address - Country:US
Practice Address - Phone:724-727-3471
Practice Address - Fax:724-727-2316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental