Healthcare Provider Details

I. General information

NPI: 1053322917
Provider Name (Legal Business Name): ROBERT GERARD ZBOROWSKI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 HARTFORD TPKE SUITE 307
VERNON CT
06066-4784
US

IV. Provider business mailing address

28 BROCKWAY RD
ELLINGTON CT
06029-2126
US

V. Phone/Fax

Practice location:
  • Phone: 860-872-8331
  • Fax:
Mailing address:
  • Phone: 860-871-6669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6838
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: