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NPI Code Detail

MEDICARE: MS. DIANE MARIE ROMARY RDH, BS, OMT

MEDICARE: MS. DIANE MARIE ROMARY RDH, BS, OMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist

General Provider Information

NPI Number : 1104488733
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DIANE MARIE ROMARY RDH, BS, OMT
Provider Business Mailing Address
First Line : 59 HAWKS LANDING CIR APT 114
Second Line :
City : VERONA
State : WI
Zip : 53593-8050
Country : US
Telephone Number : 608-239-1713
Fax Number :
Provider Business Practice Location Address
First Line : 1266 W MAIN ST
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590-1918
Country : US
Telephone Number : 608-318-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/03/2019
Last Update Date : 07/03/2019

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