MEDICARE: DR. NICK ROMANIDES D.M.D

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
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	13522	NJ

General Provider Information

NPI Number	:	1376551986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICK ROMANIDES D.M.D

Provider Business Mailing Address
First Line	:	7608 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4958
Country	:	US
Telephone Number	:	201-869-1107
Fax Number	:	201-869-8211

Provider Business Practice Location Address
First Line	:	7608 BERGENLINE AVE
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-4958
Country	:	US
Telephone Number	:	201-869-1107
Fax Number	:	201-869-8211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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