Provider Demographics
NPI:1275742694
Name:ROMAN, LUZMINDA CORPUZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUZMINDA
Middle Name:CORPUZ
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LUZMINDA
Other - Middle Name:C
Other - Last Name:ROMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3711 TRUXEL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3610
Mailing Address - Country:US
Mailing Address - Phone:916-928-9300
Mailing Address - Fax:916-928-1123
Practice Address - Street 1:3711 TRUXEL RD STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3610
Practice Address - Country:US
Practice Address - Phone:916-928-9300
Practice Address - Fax:916-928-1123
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist