Healthcare Provider Details

I. General information

NPI: 1154769529
Provider Name (Legal Business Name): BENJAMIN JOSEPH ROMENESKO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 E. EVERGREEN DR.
APPLETON WI
54913
US

IV. Provider business mailing address

2510 E. EVERGREEN DR.
APPLETON WI
54913
US

V. Phone/Fax

Practice location:
  • Phone: 920-277-2254
  • Fax: 920-903-1004
Mailing address:
  • Phone: 920-277-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7103-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: