Provider Demographics
NPI:1922026459
Name:ROMAN, JORGE A SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:ROMAN
Suffix:SR
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:PO BOX 1878
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:PR
Mailing Address - Zip Code:00677-1878
Mailing Address - Country:US
Mailing Address - Phone:787-593-0221
Mailing Address - Fax:
Practice Address - Street 1:CARR.#2 KM 96.8 BO. COCOS
Practice Address - Street 2:ALTOS FARMACIA GLORIANA
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678
Practice Address - Country:US
Practice Address - Phone:787-895-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice