Provider Demographics
NPI:1114210481
Name:ABCOM FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:ABCOM FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-231-2863
Mailing Address - Street 1:5402 MINERAL POINT RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4659
Mailing Address - Country:US
Mailing Address - Phone:608-231-2863
Mailing Address - Fax:608-231-2974
Practice Address - Street 1:5402 MINERAL POINT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4659
Practice Address - Country:US
Practice Address - Phone:608-231-2863
Practice Address - Fax:608-231-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001006015261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental