Provider Demographics
NPI:1427446913
Name:DONALD E. ROMSA, D.D.S., S.C.
Entity type:Organization
Organization Name:DONALD E. ROMSA, D.D.S., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:ROMSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-886-0147
Mailing Address - Street 1:5801 WASHINGTON AVE
Mailing Address - Street 2:102
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4057
Mailing Address - Country:US
Mailing Address - Phone:262-886-0147
Mailing Address - Fax:262-886-0570
Practice Address - Street 1:5801 WASHINGTON AVE
Practice Address - Street 2:102
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4057
Practice Address - Country:US
Practice Address - Phone:262-886-0147
Practice Address - Fax:262-886-0570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00025391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIT38347Medicare UPIN
WI000079133Medicare PIN