Healthcare Provider Details

I. General information

NPI: 1750552733
Provider Name (Legal Business Name): ROMEO N. LAUREANO, D.M.D., P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W STEPHEN FOSTER AVE STE 107
BARDSTOWN KY
40004-1457
US

IV. Provider business mailing address

120 W STEPHEN FOSTER AVE STE 107
BARDSTOWN KY
40004-1457
US

V. Phone/Fax

Practice location:
  • Phone: 502-348-1155
  • Fax: 502-348-3277
Mailing address:
  • Phone: 502-348-1155
  • Fax: 502-348-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. ROMEO NANTES LAUREANO
Title or Position: OWNER/PRESIDENT
Credential: D.M.D.
Phone: 502-348-1155