Provider Demographics
NPI:1003973348
Name:BROZEWICZ, RICHARD (DDS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:BROZEWICZ
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 1:1851 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-3574
Mailing Address - Country:US
Mailing Address - Phone:814-825-7444
Mailing Address - Fax:814-825-4924
Practice Address - Street 1:1851 E 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-3574
Practice Address - Country:US
Practice Address - Phone:814-825-7444
Practice Address - Fax:814-825-4924
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA027291-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice