Provider Demographics
NPI:1821322249
Name:DOMBOSKI, MICHAEL LEO (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEO
Last Name:DOMBOSKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1532
Mailing Address - Country:US
Mailing Address - Phone:716-375-7300
Mailing Address - Fax:
Practice Address - Street 1:623 MAIN ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1532
Practice Address - Country:US
Practice Address - Phone:716-375-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033853-11223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery