Provider Demographics
NPI:1194775908
Name:ROMANO, ERIC (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:ROMANO
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 1:3695 HIDDEN FOREST DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1473
Mailing Address - Country:US
Mailing Address - Phone:248-393-0803
Mailing Address - Fax:
Practice Address - Street 1:16638 15 MILE RD
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-3713
Practice Address - Country:US
Practice Address - Phone:586-294-4752
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI165341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice