Provider Demographics
NPI:1992008049
Name:ROUMANI COSMETIC DENTAL SERVICES
Entity Type:Organization
Organization Name:ROUMANI COSMETIC DENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUMANI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-483-9965
Mailing Address - Street 1:14 CENTRE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2109
Mailing Address - Country:US
Mailing Address - Phone:626-483-9965
Mailing Address - Fax:
Practice Address - Street 1:1811 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-1945
Practice Address - Country:US
Practice Address - Phone:626-483-9965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18553071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1730401662OtherPREVIOUS NPI NUMBER