Provider Demographics
NPI:1427865328
Name:PROVIDENCE ORTHODONTICS, LLC
Entity type:Organization
Organization Name:PROVIDENCE ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-573-6117
Mailing Address - Street 1:151 WATERMAN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2118
Mailing Address - Country:US
Mailing Address - Phone:401-274-5024
Mailing Address - Fax:
Practice Address - Street 1:151 WATERMAN ST STE 6
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2118
Practice Address - Country:US
Practice Address - Phone:401-274-5024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty