Provider Demographics
NPI:1518096148
Name:ROMEO, DOROTA (DDS)
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:
Last Name:ROMEO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 FOREST GLEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7124
Mailing Address - Country:US
Mailing Address - Phone:814-237-5887
Mailing Address - Fax:
Practice Address - Street 1:212 SOUTH ALLEN STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4840
Practice Address - Country:US
Practice Address - Phone:814-272-0308
Practice Address - Fax:814-272-0328
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028748L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
28748PAOtherDELTA DENTAL
980306OtherUNITED CONCORDIA