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NPI Code Detail

MEDICARE: DR. IVAN ROMAN DDS

MEDICARE: DR. IVAN ROMAN DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223P0300XPeriodontics40114CA

General Provider Information

NPI Number : 1023001831
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IVAN ROMAN DDS
Provider Business Mailing Address
First Line : 3259 CATLIN AVE
Second Line : NAVAL HEALTH CLINIC QUANTICO
City : QUANTICO
State : VA
Zip : 22134
Country : US
Telephone Number : 703-784-2802
Fax Number :
Provider Business Practice Location Address
First Line : PSC 482 BOX 1600
Second Line :
City : FPO
State : AP
Zip : 96362-0017
Country : US
Telephone Number : 98-971-9355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2005
Last Update Date : 02/25/2025

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