Provider Demographics
NPI:1154532877
Name:ROMAN, ERIC JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JAMES
Last Name:ROMAN
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 1:1404 JORDAN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4698
Mailing Address - Country:US
Mailing Address - Phone:919-225-0613
Mailing Address - Fax:801-457-0683
Practice Address - Street 1:5075 MORGANTON RD STE 12
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1542
Practice Address - Country:US
Practice Address - Phone:910-864-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8397122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist