MEDICARE: DR. ROBERT GORDON STROMBERG DDS

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	122300000X	Dentist	5000968015	WI

General Provider Information

NPI Number	:	1598762866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GORDON STROMBERG DDS

Provider Business Mailing Address
First Line	:	819 LAKE SHORE DR W
Second Line	:
City	:	ASHLAND
State	:	WI
Zip	:	54806-1443
Country	:	US
Telephone Number	:	715-682-6675
Fax Number	:	715-682-6747

Provider Business Practice Location Address
First Line	:	819 LAKE SHORE DR W
Second Line	:
City	:	ASHLAND
State	:	WI
Zip	:	54806-1443
Country	:	US
Telephone Number	:	715-682-6675
Fax Number	:	715-682-6747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/08/2007

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