Provider Demographics
NPI:1538826144
Name:CROMBACH & GILSON DDS PC
Entity type:Organization
Organization Name:CROMBACH & GILSON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYJO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRO TOBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-524-7433
Mailing Address - Street 1:6200 SLOCUM RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9142
Mailing Address - Country:US
Mailing Address - Phone:315-524-7433
Mailing Address - Fax:
Practice Address - Street 1:6200 SLOCUM RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-9142
Practice Address - Country:US
Practice Address - Phone:315-524-7433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental