Provider Demographics
NPI:1760896211
Name:GOOD NEWS DENTAL EAST, PLLC
Entity Type:Organization
Organization Name:GOOD NEWS DENTAL EAST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-594-4377
Mailing Address - Street 1:26400 AMHEARST CIR
Mailing Address - Street 2:SUITE # 201
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7582
Mailing Address - Country:US
Mailing Address - Phone:319-594-4377
Mailing Address - Fax:
Practice Address - Street 1:26400 AMHEARST CIR
Practice Address - Street 2:SUITE # 201
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-7582
Practice Address - Country:US
Practice Address - Phone:319-594-4377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08905261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service