Provider Demographics
NPI:1497182315
Name:ROMAN, DORIA ELENA (RDH)
Entity Type:Individual
Prefix:
First Name:DORIA
Middle Name:ELENA
Last Name:ROMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:DORIA
Other - Middle Name:ELENA
Other - Last Name:NECHIFOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13040 ESSEN LN
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-6757
Mailing Address - Country:US
Mailing Address - Phone:773-319-7652
Mailing Address - Fax:
Practice Address - Street 1:13040 ESSEN LN
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-6757
Practice Address - Country:US
Practice Address - Phone:773-319-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27297124Q00000X
IL020014122124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist