Provider Demographics
NPI:1881683076
Name:ROMAN, MARIA ROMANA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ROMANA
Last Name:ROMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E PHILLIP RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1858
Mailing Address - Country:US
Mailing Address - Phone:847-367-4190
Mailing Address - Fax:847-367-5010
Practice Address - Street 1:1 E PHILLIP RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1858
Practice Address - Country:US
Practice Address - Phone:847-367-4190
Practice Address - Fax:847-367-5010
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0258271223G0001X
WI5595-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice