Provider Demographics
NPI:1366641227
Name:ROMAN, JOHANNA
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:ROMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 PASEO ADONIS
Mailing Address - Street 2:LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4224
Mailing Address - Country:US
Mailing Address - Phone:787-217-5549
Mailing Address - Fax:
Practice Address - Street 1:AVENUE AMALIA PAOLI
Practice Address - Street 2:HP-16
Practice Address - City:LEVITTOWN, TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice