Provider Demographics
NPI:1649508813
Name:GAVRILMAN, ROMAN (DMD)
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:GAVRILMAN
Suffix:
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 1:25 ROCHESTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3214
Mailing Address - Country:US
Mailing Address - Phone:603-335-9339
Mailing Address - Fax:603-335-3888
Practice Address - Street 1:25 ROCHESTER HILL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3214
Practice Address - Country:US
Practice Address - Phone:603-335-9339
Practice Address - Fax:603-335-3888
Is Sole Proprietor?:No
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH03305122300000X
MEDEN3821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist