Healthcare Provider Details

I. General information

NPI: 1922098615
Provider Name (Legal Business Name): ROMEO CARRAMANZANA SIRA JR. DENTAL HYGIENIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 561 BOX 388
FPO AP
96310
US

IV. Provider business mailing address

PSC 561 BOX 388
FPO AP
96310
US

V. Phone/Fax

Practice location:
  • Phone: 11-818-2779
  • Fax:
Mailing address:
  • Phone: 11-818-2779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: