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General NPI Number Information
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NPI Number | 1558017459
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Entity Type | Organization
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Legal Business Name | CM ROMENESKO DDS SC
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Dates
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Enumeration Date | 03/01/2022
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 2510 E EVERGREEN DR
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City | APPLETON
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State | WI
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Zip | 54913
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Country | US
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Telephone | 920-739-7848
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Fax |
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Provider Business Mailing Address
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Address Line | 2510 E. EVERGREEN DRIVE
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City | APPLETON
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State | WI
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Zip | 54913
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Country | US
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Telephone | 920-739-7848
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Fax | 920-903-1004
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | KENDALL A BUTLER
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Credential |
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Telephone | 920-739-7848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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