Provider Demographics
NPI:1316462146
Name:ROMAY, LEAH KAITLYN (DDS)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:KAITLYN
Last Name:ROMAY
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:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:GLYNDON
Mailing Address - State:MD
Mailing Address - Zip Code:21071-0205
Mailing Address - Country:US
Mailing Address - Phone:410-833-4664
Mailing Address - Fax:
Practice Address - Street 1:4817 BUTLER RD
Practice Address - Street 2:
Practice Address - City:GLYNDON
Practice Address - State:MD
Practice Address - Zip Code:21071-2100
Practice Address - Country:US
Practice Address - Phone:410-833-4664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-14
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16052122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist