Provider Demographics
NPI:1750343000
Name:ROMANO, JOHN TA (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TA
Last Name:ROMANO
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 1:463 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02909-1625
Mailing Address - Country:US
Mailing Address - Phone:401-751-4343
Mailing Address - Fax:401-751-4347
Practice Address - Street 1:463 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1625
Practice Address - Country:US
Practice Address - Phone:401-751-4343
Practice Address - Fax:401-751-4347
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist