Provider Demographics
NPI:1104488733
Name:ROMARY, DIANE MARIE (RDH, BS, OMT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MARIE
Last Name:ROMARY
Suffix:
Gender:F
Credentials:RDH, BS, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 HAWKS LANDING CIR APT 114
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8050
Mailing Address - Country:US
Mailing Address - Phone:608-239-1713
Mailing Address - Fax:
Practice Address - Street 1:1266 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1918
Practice Address - Country:US
Practice Address - Phone:608-318-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist