Healthcare Provider Details

I. General information

NPI: 1194775908
Provider Name (Legal Business Name): ERIC ROMANO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16638 15 MILE RD
FRASER MI
48026-3713
US

IV. Provider business mailing address

3695 HIDDEN FOREST DR
LAKE ORION MI
48359-1473
US

V. Phone/Fax

Practice location:
  • Phone: 586-294-4752
  • Fax:
Mailing address:
  • Phone: 248-393-0803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16534
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: