Provider Demographics
NPI:1215124862
Name:ROMENESKO, CALLIE IRENE (DDS)
Entity type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:IRENE
Last Name:ROMENESKO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 TRUMAN ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-2215
Mailing Address - Country:US
Mailing Address - Phone:920-733-3339
Mailing Address - Fax:
Practice Address - Street 1:1020 TRUMAN ST
Practice Address - Street 2:UNIT A
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-2215
Practice Address - Country:US
Practice Address - Phone:920-733-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice