Healthcare Provider Details

I. General information

NPI: 1528373180
Provider Name (Legal Business Name): VROMAN ORTHODONTICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2010
Last Update Date: 08/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 1ST STREET A
MOLINE IL
61265-7745
US

IV. Provider business mailing address

2131 1ST STREET A
MOLINE IL
61265-7745
US

V. Phone/Fax

Practice location:
  • Phone: 309-797-0106
  • Fax: 309-797-0180
Mailing address:
  • Phone: 309-797-0106
  • Fax: 309-797-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number08686
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number019028210
License Number StateIL

VIII. Authorized Official

Name: DR. MAURA J VROMAN
Title or Position: OWNER/ORTHODONTIST
Credential: D.D.S., M.S.
Phone: 309-797-0106