Provider Demographics
NPI:1871679829
Name:ROMAN, NESTOR LUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:LUIS
Last Name:ROMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CLAFLIN RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2521
Mailing Address - Country:US
Mailing Address - Phone:785-239-4174
Mailing Address - Fax:785-239-7245
Practice Address - Street 1:600 CAISSON HILL ROAD
Practice Address - Street 2:
Practice Address - City:FT. RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-5043
Practice Address - Country:US
Practice Address - Phone:785-239-7241
Practice Address - Fax:785-239-7245
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4973-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice