Healthcare Provider Details

I. General information

NPI: 1164503801
Provider Name (Legal Business Name): RODRIGO ROMANO DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 SW 62ND AVE STE A-1
SOUTH MIAMI FL
33143-4908
US

IV. Provider business mailing address

7701 SW 62ND AVE STE A-1
SOUTH MIAMI FL
33143-4908
US

V. Phone/Fax

Practice location:
  • Phone: 305-403-6222
  • Fax: 305-403-4222
Mailing address:
  • Phone: 305-403-6222
  • Fax: 305-403-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN16909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: