Provider Demographics
NPI:1992784136
Name:BALOGH-CROMBIE, DEBRA A (DDS)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:BALOGH-CROMBIE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9709
Mailing Address - Country:US
Mailing Address - Phone:440-992-2700
Mailing Address - Fax:440-964-0542
Practice Address - Street 1:2010 W 19TH ST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-9709
Practice Address - Country:US
Practice Address - Phone:440-992-2700
Practice Address - Fax:440-964-0542
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice