Provider Demographics
NPI:1992816763
Name:BROMBACHER, ROBERT CARL (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARL
Last Name:BROMBACHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-5103
Mailing Address - Country:US
Mailing Address - Phone:760-941-1015
Mailing Address - Fax:760-941-1016
Practice Address - Street 1:167 CEDAR RD
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-5103
Practice Address - Country:US
Practice Address - Phone:760-941-1015
Practice Address - Fax:760-941-1016
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist