Provider Demographics
NPI:1902015118
Name:BROMLEY, JOSEPH JACOB (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JACOB
Last Name:BROMLEY
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 1:5214 EMMELINE DR
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84065-1933
Mailing Address - Country:US
Mailing Address - Phone:801-253-8633
Mailing Address - Fax:801-253-9277
Practice Address - Street 1:4019 W. 12600 S.
Practice Address - Street 2:SUITE 100
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065
Practice Address - Country:US
Practice Address - Phone:801-253-8633
Practice Address - Fax:801-253-9277
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5788334-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist