Provider Demographics
NPI:1720103542
Name:ROMINE, LEE M (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:M
Last Name:ROMINE
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5725
Mailing Address - Country:US
Mailing Address - Phone:318-352-1729
Mailing Address - Fax:318-352-1715
Practice Address - Street 1:128 E 5TH ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5725
Practice Address - Country:US
Practice Address - Phone:318-352-1729
Practice Address - Fax:318-352-1715
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics