Provider Demographics
NPI:1194933440
Name:ROMANOWSKI, STANLEY S (DDS)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:S
Last Name:ROMANOWSKI
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 1:528 MAIN ST.
Mailing Address - Street 2:P.O. BOX 481
Mailing Address - City:CHENANGO BRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13745
Mailing Address - Country:US
Mailing Address - Phone:607-648-4113
Mailing Address - Fax:
Practice Address - Street 1:528 MAIN ST.
Practice Address - Street 2:
Practice Address - City:CHENANGO BRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13745
Practice Address - Country:US
Practice Address - Phone:607-648-4113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02244782Medicaid