Provider Demographics
NPI:1659935773
Name:ARONOV, ROMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:
Last Name:ARONOV
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 1:11714 85TH AVE APT B1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1816
Mailing Address - Country:US
Mailing Address - Phone:917-513-6431
Mailing Address - Fax:
Practice Address - Street 1:13614 NORTHERN BLVD STE A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6511
Practice Address - Country:US
Practice Address - Phone:718-445-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0612661223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice