Provider Demographics
NPI:1013365600
Name:NOMIE, ROLAND H (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:H
Last Name:NOMIE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-4101
Mailing Address - Country:US
Mailing Address - Phone:610-691-3311
Mailing Address - Fax:
Practice Address - Street 1:1003 BROADWAY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-4101
Practice Address - Country:US
Practice Address - Phone:610-691-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist