Provider Demographics
NPI:1154494979
Name:DOMBROSKI, STANLEY WAYNE (DDS)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:WAYNE
Last Name:DOMBROSKI
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 1:150 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NANTICOKE
Mailing Address - State:PA
Mailing Address - Zip Code:18634-2402
Mailing Address - Country:US
Mailing Address - Phone:570-735-0320
Mailing Address - Fax:570-735-0320
Practice Address - Street 1:150 E GREEN ST
Practice Address - Street 2:
Practice Address - City:NANTICOKE
Practice Address - State:PA
Practice Address - Zip Code:18634-2402
Practice Address - Country:US
Practice Address - Phone:570-735-0320
Practice Address - Fax:570-735-0320
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO19093L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist