MEDICARE: DR. AMIRO EDUARDO ROMAN DDS

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	122300000X	Dentist	050758-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407868730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIRO EDUARDO ROMAN DDS

Provider Business Mailing Address
First Line	:	2406 WALTON AVE # SOB
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-6454
Country	:	US
Telephone Number	:	718-364-7791
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 WALTON AVE #SOB
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-6402
Country	:	US
Telephone Number	:	718-364-7791
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	03/01/2011

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