MEDICARE: JONATHAN J. BROMBOZ, DDS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	14423	FL

General Provider Information

NPI Number	:	1518176999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN J. BROMBOZ, DDS, PA

Provider Business Mailing Address
First Line	:	2701 PARK DR
Second Line	:	SUITE 4
City	:	CLEARWATER
State	:	FL
Zip	:	33763-1021
Country	:	US
Telephone Number	:	727-712-3837
Fax Number	:	727-712-0105

Provider Business Practice Location Address
First Line	:	2701 PARK DR
Second Line	:	SUITE 4
City	:	CLEARWATER
State	:	FL
Zip	:	33763-1021
Country	:	US
Telephone Number	:	727-712-3837
Fax Number	:	727-712-0105

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JONATHAN J BROMBOZ
Credential	:	DDS
Telephone Number	:	727-712-3837

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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