Provider Demographics
NPI:1134828841
Name:ROMAN, ANTONIO JOSE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:JOSE
Last Name:ROMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4719 AUDUBON PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5921
Mailing Address - Country:US
Mailing Address - Phone:214-307-2487
Mailing Address - Fax:
Practice Address - Street 1:23714 HARDY OAK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-1960
Practice Address - Country:US
Practice Address - Phone:210-664-3479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX406561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice