Provider Demographics
NPI:1164432142
Name:EDWARD J. ROMAN D.D.S P.C
Entity Type:Organization
Organization Name:EDWARD J. ROMAN D.D.S P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-228-4600
Mailing Address - Street 1:378 W CHESTNUT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4659
Mailing Address - Country:US
Mailing Address - Phone:724-228-4600
Mailing Address - Fax:724-228-4619
Practice Address - Street 1:378 W CHESTNUT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4659
Practice Address - Country:US
Practice Address - Phone:724-228-4600
Practice Address - Fax:724-228-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019941L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty