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General NPI Number Information
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NPI Number | 1760896211
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Entity Type | Organization
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Legal Business Name | GOOD NEWS DENTAL EAST, PLLC
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 06/12/2014
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Provider Practice Location Address
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Address Line | 26400 AMHEARST CIR SUITE # 201
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City | BEACHWOOD
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State | OH
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Zip | 44122-7582
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Country | US
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Telephone | 319-594-4377
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Fax |
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Provider Business Mailing Address
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Address Line | 26400 AMHEARST CIR SUITE # 201
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City | BEACHWOOD
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State | OH
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Zip | 44122-7582
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Country | US
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Telephone | 319-594-4377
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARCO ROUMAN
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Credential | DDS
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Telephone | 319-594-4377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 08905
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License Number State | IA
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