Healthcare Provider Details

I. General information

NPI: 1437218302
Provider Name (Legal Business Name): DONALD EDWARD ROMSA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 WASHINGTON AVENUE SUITE 102
RACINE WI
53406
US

IV. Provider business mailing address

5801 WASHINGTON AVENUE SUITE 102
RACINE WI
53406
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:
Title or Position:
Credential:
Phone: