Provider Demographics
NPI:1427258292
Name:ROMEO FAMILY DENTISTRY
Entity type:Organization
Organization Name:ROMEO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-752-3589
Mailing Address - Street 1:64580 VAN DYKE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2857
Mailing Address - Country:US
Mailing Address - Phone:586-752-3589
Mailing Address - Fax:586-752-0198
Practice Address - Street 1:64580 VAN DYKE RD
Practice Address - Street 2:SUITE B
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48095-2857
Practice Address - Country:US
Practice Address - Phone:586-752-3589
Practice Address - Fax:586-752-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty