Healthcare Provider Details

I. General information

NPI: 1336070952
Provider Name (Legal Business Name): ROMAN MAMMO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 MERRIMAN RD
GARDEN CITY MI
48135-1978
US

IV. Provider business mailing address

7364 ESSEX DR
WEST BLOOMFIELD MI
48322-1140
US

V. Phone/Fax

Practice location:
  • Phone: 734-680-0420
  • Fax:
Mailing address:
  • Phone: 619-818-2833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: