Healthcare Provider Details

I. General information

NPI: 1356570303
Provider Name (Legal Business Name): CELIA MARINA ROMAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 NW 107TH AVE STE 505
DORAL FL
33178-2785
US

IV. Provider business mailing address

3905 NW 107TH AVE STE 505
DORAL FL
33178-2785
US

V. Phone/Fax

Practice location:
  • Phone: 305-400-9296
  • Fax: 786-921-0205
Mailing address:
  • Phone: 305-400-9296
  • Fax: 786-921-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN21626
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: