Provider Demographics
NPI:1861568677
Name:FORTH TROMBLEE DENTAL ASSOCIATION PLLC
Entity type:Organization
Organization Name:FORTH TROMBLEE DENTAL ASSOCIATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TROMBLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPS
Authorized Official - Phone:315-458-4794
Mailing Address - Street 1:3903 BREWERTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:315-458-4794
Mailing Address - Fax:315-458-4828
Practice Address - Street 1:3903 BREWERTON RD
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212
Practice Address - Country:US
Practice Address - Phone:315-458-4794
Practice Address - Fax:315-458-4828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty