Provider Demographics
NPI:1659496982
Name:TROMBATORE, GARY (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:TROMBATORE
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 1:3840 WOODRUFF AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-2148
Mailing Address - Country:US
Mailing Address - Phone:562-425-0545
Mailing Address - Fax:562-425-8065
Practice Address - Street 1:3840 WOODRUFF AVE STE 104
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-2148
Practice Address - Country:US
Practice Address - Phone:562-425-0545
Practice Address - Fax:562-425-8065
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice