Provider Demographics
NPI:1164544904
Name:ROMAN, GUILLERMO A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:A
Last Name:ROMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16311 VENTURA BLVD STE 1066
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4350
Mailing Address - Country:US
Mailing Address - Phone:818-906-0455
Mailing Address - Fax:818-906-9848
Practice Address - Street 1:16311 VENTURA BLVD STE 1066
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4350
Practice Address - Country:US
Practice Address - Phone:818-906-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA344131223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics