Provider Demographics
NPI:1104937192
Name:ROME FAMILY & COSMETIC DENTISTRY
Entity type:Organization
Organization Name:ROME FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:B
Authorized Official - Last Name:OYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PC
Authorized Official - Phone:706-235-1186
Mailing Address - Street 1:19C JOHN MADDOX DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1413
Mailing Address - Country:US
Mailing Address - Phone:706-235-1186
Mailing Address - Fax:706-234-9007
Practice Address - Street 1:19C JOHN MADDOX DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1413
Practice Address - Country:US
Practice Address - Phone:706-235-1186
Practice Address - Fax:706-234-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA118801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00910511-AMedicaid