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General NPI Number Information
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NPI Number | 1427446913
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Entity Type | Organization
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Legal Business Name | DONALD E. ROMSA, D.D.S., S.C.
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 5801 WASHINGTON AVE 102
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City | MOUNT PLEASANT
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State | WI
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Zip | 53406-4057
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Country | US
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Telephone | 262-886-0147
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Fax | 262-886-0570
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Provider Business Mailing Address
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Address Line | 5801 WASHINGTON AVE 102
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City | MOUNT PLEASANT
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State | WI
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Zip | 53406-4057
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Country | US
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Telephone | 262-886-0147
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Fax | 262-886-0570
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | DR. DONALD EDWARD ROMSA
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Credential | D.D.S.
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Telephone | 262-886-0147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0002539
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License Number State | WI
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