MEDICARE: DR. BARBARA PEARL ROOMKIN DMD

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	1223G0001X	General Practice Dentistry	006501	CT

General Provider Information

NPI Number	:	1780660936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA PEARL ROOMKIN DMD

Provider Business Mailing Address
First Line	:	14 GALLIVAN LN
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-1208
Country	:	US
Telephone Number	:	860-367-0688
Fax Number	:	860-367-0668

Provider Business Practice Location Address
First Line	:	14 GALLIVAN LN
Second Line	:
City	:	UNCASVILLE
State	:	CT
Zip	:	06382-1208
Country	:	US
Telephone Number	:	860-367-0688
Fax Number	:	860-367-0668

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	01/07/2013

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