Provider Demographics
NPI:1376665281
Name:GOLOMBISKY, JEFFREY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:GOLOMBISKY
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 1:1336 E M 21
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-9039
Mailing Address - Country:US
Mailing Address - Phone:989-723-8135
Mailing Address - Fax:989-723-8649
Practice Address - Street 1:1336 E M 21
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9039
Practice Address - Country:US
Practice Address - Phone:989-723-8135
Practice Address - Fax:989-723-8649
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010131491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice