Provider Demographics
NPI:1972755098
Name:DIANE D ROMAINE, DMD, PA
Entity type:Organization
Organization Name:DIANE D ROMAINE, DMD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROMAINE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:301-689-6780
Mailing Address - Street 1:151 BISHOP MURPHY DR
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-1329
Mailing Address - Country:US
Mailing Address - Phone:301-689-6780
Mailing Address - Fax:301-687-8011
Practice Address - Street 1:151 BISHOP MURPHY DR
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-1329
Practice Address - Country:US
Practice Address - Phone:301-689-6780
Practice Address - Fax:301-687-8011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty