Provider Demographics
NPI:1760516777
Name:MYRON J. BROMBERG, DDS, INC.
Entity Type:Organization
Organization Name:MYRON J. BROMBERG, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:BROMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-345-3366
Mailing Address - Street 1:7012 RESEDA BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4219
Mailing Address - Country:US
Mailing Address - Phone:818-345-3366
Mailing Address - Fax:
Practice Address - Street 1:7012 RESEDA BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4219
Practice Address - Country:US
Practice Address - Phone:818-345-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty