Provider Demographics
NPI:1144386129
Name:ROMAN, BRENDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 ARLINGTON CENTRE BLVD
Mailing Address - Street 2:STE 220
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2959
Mailing Address - Country:US
Mailing Address - Phone:614-457-1481
Mailing Address - Fax:
Practice Address - Street 1:5025 ARLINGTON CENTRE BLVD
Practice Address - Street 2:STE 220
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2959
Practice Address - Country:US
Practice Address - Phone:614-457-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-207801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice