Provider Demographics
NPI:1285104810
Name:ROMAN DENTAL LLC
Entity type:Organization
Organization Name:ROMAN DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN ROCCA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-619-3774
Mailing Address - Street 1:2745 PASEO ADONIS 2DA SECC.
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-619-3774
Mailing Address - Fax:
Practice Address - Street 1:CARR. #2 KM 65.2 FACTOR
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-650-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty