Provider Demographics
NPI:1184764664
Name:DOBROWOLSKI, DONALD A (DMD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:A
Last Name:DOBROWOLSKI
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 1:107 B ST
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7256
Mailing Address - Country:US
Mailing Address - Phone:732-255-7049
Mailing Address - Fax:732-255-8553
Practice Address - Street 1:445 BRICK BLVD
Practice Address - Street 2:SUITE #108
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6048
Practice Address - Country:US
Practice Address - Phone:732-477-8686
Practice Address - Fax:732-477-6398
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ130381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice