Provider Demographics
NPI:1366612004
Name:ROMANELLI DENTAL OFFICE PC
Entity type:Organization
Organization Name:ROMANELLI DENTAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-458-7122
Mailing Address - Street 1:2401 HARNISH DR
Mailing Address - Street 2:STE 102
Mailing Address - City:ALGONQUIN
Mailing Address - State:IL
Mailing Address - Zip Code:60102-6846
Mailing Address - Country:US
Mailing Address - Phone:847-458-7122
Mailing Address - Fax:847-458-6557
Practice Address - Street 1:2401 HARNISH DR
Practice Address - Street 2:STE 102
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102
Practice Address - Country:US
Practice Address - Phone:847-458-7122
Practice Address - Fax:847-458-6557
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROMANELLI DENTAL OFFICE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty