Provider Demographics
NPI:1821024571
Name:BROSY, PAUL ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:BROSY
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 1:175 CADILLAC PL
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4355
Mailing Address - Country:US
Mailing Address - Phone:775-826-1988
Mailing Address - Fax:775-826-1101
Practice Address - Street 1:175 CADILLAC PL
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4355
Practice Address - Country:US
Practice Address - Phone:775-826-1988
Practice Address - Fax:775-826-1101
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice