MEDICARE: DR. ERIC SCOTT BROBERG D.D.S.

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	1223G0001X	General Practice Dentistry	27963	TX

General Provider Information

NPI Number	:	1972867349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC SCOTT BROBERG D.D.S.

Provider Business Mailing Address
First Line	:	9521 W US HIGHWAY 290
Second Line	:	SUITE 103
City	:	AUSTIN
State	:	TX
Zip	:	78736-7896
Country	:	US
Telephone Number	:	512-888-9453
Fax Number	:	512-888-9704

Provider Business Practice Location Address
First Line	:	9521 W US HIGHWAY 290
Second Line	:	SUITE 103
City	:	AUSTIN
State	:	TX
Zip	:	78736-7896
Country	:	US
Telephone Number	:	512-888-9453
Fax Number	:	512-888-9704

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

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	04/26/2016

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