Healthcare Provider Details

I. General information

NPI: 1427446913
Provider Name (Legal Business Name): DONALD E. ROMSA, D.D.S., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 WASHINGTON AVE 102
MOUNT PLEASANT WI
53406-4057
US

IV. Provider business mailing address

5801 WASHINGTON AVE 102
MOUNT PLEASANT WI
53406-4057
US

V. Phone/Fax

Practice location:
  • Phone: 262-886-0147
  • Fax: 262-886-0570
Mailing address:
  • Phone: 262-886-0147
  • Fax: 262-886-0570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0002539
License Number StateWI

VIII. Authorized Official

Name: DR. DONALD EDWARD ROMSA
Title or Position: ORAL SURGEON
Credential: D.D.S.
Phone: 262-886-0147