MEDICARE: DR. JENNIFER ANN ROME D.D.S

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
1	1223G0001X	General Practice Dentistry	6310	LA

General Provider Information

NPI Number	:	1356606941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ANN ROME D.D.S

Provider Business Mailing Address
First Line	:	1901 MANHATTAN BLVD
Second Line	:	BLDG F SUITE 201
City	:	HARVEY
State	:	LA
Zip	:	70058-3582
Country	:	US
Telephone Number	:	504-347-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1901 MANHATTAN BLVD
Second Line	:	BLDG F SUITE 201
City	:	HARVEY
State	:	LA
Zip	:	70058-3582
Country	:	US
Telephone Number	:	504-347-6000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/10/2012

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