Provider Demographics
NPI:1801008933
Name:MAXIMO A. ROMAN DDS, PA
Entity Type:Organization
Organization Name:MAXIMO A. ROMAN DDS, PA
Other - Org Name:GABLES DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXIMO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-448-1999
Mailing Address - Street 1:747 PONCE DE LEON BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134
Mailing Address - Country:US
Mailing Address - Phone:305-448-1999
Mailing Address - Fax:305-448-1985
Practice Address - Street 1:747 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-448-1999
Practice Address - Fax:305-448-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14510122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty