MEDICARE: NICHOLAS ROBERT ROMANS DMD, MSD

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	D012045	AZ
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	D012045	AZ

General Provider Information

NPI Number	:	1497426183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ROBERT ROMANS DMD, MSD

Provider Business Mailing Address
First Line	:	6319 E WALTANN LN
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-1945
Country	:	US
Telephone Number	:	620-205-9494
Fax Number	:

Provider Business Practice Location Address
First Line	:	21083 N JOHN WAYNE PKWY
Second Line	:
City	:	MARICOPA
State	:	AZ
Zip	:	85139-2959
Country	:	US
Telephone Number	:	623-343-7400
Fax Number	:

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

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	09/17/2024

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