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General NPI Number Information
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NPI Number | 1912433913
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Entity Type | Individual
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Provider Name | JONATHAN LOMBOY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 7410 W ADAMS AVE STE 140
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City | TEMPLE
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State | TX
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Zip | 76502-5892
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Country | US
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Telephone | 254-405-6066
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Fax |
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Provider Business Mailing Address
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Address Line | 101 COLORADO ST APT 2006
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City | AUSTIN
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State | TX
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Zip | 78701-4131
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Country | US
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Telephone | 828-514-9063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 36074
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License Number State | TX
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