Provider Demographics
NPI:1295804011
Name:ROMAN, RICHARD JOHN (DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JOHN
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 1:2 COUNTRYSIDE ROAD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-263-7988
Mailing Address - Fax:978-263-8424
Practice Address - Street 1:296 GREAT ROAD
Practice Address - Street 2:GREAT ROAD DENTAL ASSOCS
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:978-263-8525
Practice Address - Fax:978-263-2955
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice