Healthcare Provider Details

I. General information

NPI: 1528486214
Provider Name (Legal Business Name): DONNA LYNN ROMM RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 OSUNA RD NE STE 4A
ALBUQUERQUE NM
87111-2071
US

IV. Provider business mailing address

8400 OSUNA RD NE STE 4A
ALBUQUERQUE NM
87111-2071
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-4700
  • Fax:
Mailing address:
  • Phone: 505-294-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH2482
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: