Provider Demographics
NPI:1316014640
Name:BROSCHINSKY, CLIFF K (DDS)
Entity Type:Individual
Prefix:
First Name:CLIFF
Middle Name:K
Last Name:BROSCHINSKY
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 1:2491 SAN RAMON VALLEY BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1677
Mailing Address - Country:US
Mailing Address - Phone:925-362-8180
Mailing Address - Fax:925-362-8182
Practice Address - Street 1:2491 SAN RAMON VALLEY BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1677
Practice Address - Country:US
Practice Address - Phone:925-362-8180
Practice Address - Fax:925-362-8182
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist