Provider Demographics
NPI:1023088143
Name:DOMBROWSKI, JEFFREY S (DDS,MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:DOMBROWSKI
Suffix:
Gender:M
Credentials:DDS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 GOLDEN TRAIL COURT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARROLLTON,
Mailing Address - State:TX
Mailing Address - Zip Code:75010
Mailing Address - Country:US
Mailing Address - Phone:972-395-7630
Mailing Address - Fax:972-395-7625
Practice Address - Street 1:1813 GOLDEN TRAIL COURT
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-395-7630
Practice Address - Fax:972-395-7625
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO74251223S0112X
TX28274122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02074250Medicaid
COC61808Medicare ID - Type Unspecified
CO02074250Medicaid