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General NPI Number Information
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NPI Number | 1992008049
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Entity Type | Organization
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Legal Business Name | ROUMANI COSMETIC DENTAL SERVICES
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 1811 CENTRE ST
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City | WEST ROXBURY
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State | MA
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Zip | 02132-1945
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Country | US
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Telephone | 626-483-9965
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Fax |
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Provider Business Mailing Address
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Address Line | 14 CENTRE ST APT 4
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City | CAMBRIDGE
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State | MA
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Zip | 02139-2109
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Country | US
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Telephone | 626-483-9965
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LEILA ROUMANI
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Credential | D.M.D.
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Telephone | 626-483-9965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1855307
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License Number State | MA
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