Provider Demographics
NPI:1861601130
Name:BROMBACKER, DONALD NORMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:NORMAN
Last Name:BROMBACKER
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 1:53 E DAYTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-5549
Mailing Address - Country:US
Mailing Address - Phone:203-265-5573
Mailing Address - Fax:
Practice Address - Street 1:470 MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06455-1210
Practice Address - Country:US
Practice Address - Phone:860-349-1007
Practice Address - Fax:
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
CT4529122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist