Provider Demographics
NPI:1972867349
Name:BROBERG, ERIC SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SCOTT
Last Name:BROBERG
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 1:9521 W US HIGHWAY 290
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-7896
Mailing Address - Country:US
Mailing Address - Phone:512-888-9453
Mailing Address - Fax:512-888-9704
Practice Address - Street 1:9521 W US HIGHWAY 290
Practice Address - Street 2:SUITE 103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-7896
Practice Address - Country:US
Practice Address - Phone:512-888-9453
Practice Address - Fax:512-888-9704
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX279631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice