Provider Demographics
NPI:1932199486
Name:DABREO, ERNEST L (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:L
Last Name:DABREO
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4881 SUGAR MAPLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WPAFB
Mailing Address - State:OH
Mailing Address - Zip Code:45385
Mailing Address - Country:US
Mailing Address - Phone:937-257-9632
Mailing Address - Fax:
Practice Address - Street 1:72D MEDICAL GROUP
Practice Address - Street 2:1094 AIR DEPOT BLVD
Practice Address - City:TINKER AFB
Practice Address - State:OK
Practice Address - Zip Code:73130
Practice Address - Country:US
Practice Address - Phone:405-582-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540991223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics