Provider Demographics
NPI:1821133703
Name:ROMAINE, DIANE D (DMD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:D
Last Name:ROMAINE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 BISHOP MURPHY DRIVE
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532
Mailing Address - Country:US
Mailing Address - Phone:301-689-6780
Mailing Address - Fax:301-777-0237
Practice Address - Street 1:151 BISHOP MURPHY DRIVE
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532
Practice Address - Country:US
Practice Address - Phone:301-689-6780
Practice Address - Fax:301-777-0237
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice