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General NPI Number Information
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NPI Number | 1801008933
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Entity Type | Organization
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Legal Business Name | MAXIMO A. ROMAN DDS, PA
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 747 PONCE DE LEON BLVD SUITE 301
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City | CORAL GABLES
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State | FL
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Zip | 33134
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Country | US
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Telephone | 305-448-1999
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Fax | 305-448-1985
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Provider Business Mailing Address
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Address Line | 747 PONCE DE LEON BLVD SUITE 301
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City | CORAL GABLES
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State | FL
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Zip | 33134
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Country | US
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Telephone | 305-448-1999
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Fax | 305-448-1985
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAXIMO A ROMAN
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Credential | DDS
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Telephone | 305-448-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN14510
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License Number State | FL
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