Provider Demographics
NPI:1053322917
Name:ZBOROWSKI, ROBERT GERARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GERARD
Last Name:ZBOROWSKI
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 1:28 BROCKWAY RD
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-2126
Mailing Address - Country:US
Mailing Address - Phone:860-871-6669
Mailing Address - Fax:
Practice Address - Street 1:281 HARTFORD TPKE
Practice Address - Street 2:SUITE 307
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4784
Practice Address - Country:US
Practice Address - Phone:860-872-8331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT68381223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT22624Medicare UPIN