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General NPI Number Information
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NPI Number | 1669519237
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Entity Type | Individual
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Provider Name | BRUCE WALTER ROMAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 500 SE DOUGLAS AVE
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City | ROSEBURG
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State | OR
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Zip | 97470-3120
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Country | US
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Telephone | 541-672-5721
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Fax | 541-672-7663
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Provider Business Mailing Address
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Address Line | PO BOX 609
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City | WINCHESTER
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State | OR
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Zip | 97495-0609
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Country | US
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Telephone | 541-672-7100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D8534
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 23754
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License Number State | CA
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