Provider Demographics
NPI:1407868730
Name:ROMAN, AMIRO EDUARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMIRO
Middle Name:EDUARDO
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 1:2406 WALTON AVE # SOB
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6454
Mailing Address - Country:US
Mailing Address - Phone:718-364-7791
Mailing Address - Fax:
Practice Address - Street 1:2406 WALTON AVE #SOB
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6402
Practice Address - Country:US
Practice Address - Phone:718-364-7791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050758-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02411810Medicaid