Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 28274 | TX |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 28274 | TX |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 7425 | CO |
NPI | 1023088143 |
---|---|
Provider Name | Dr. Jeffrey S. Dombrowski |
First Address | Carrollton,, TX 75010 |
Second Address | Carrollton, TX 75010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 06/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02074250 | (05) | CO |
G42532 | (02) | CO |