Provider Demographics
NPI:1750552733
Name:ROMEO N. LAUREANO, D.M.D., P.S.C.
Entity type:Organization
Organization Name:ROMEO N. LAUREANO, D.M.D., P.S.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:NANTES
Authorized Official - Last Name:LAUREANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-348-1155
Mailing Address - Street 1:120 W STEPHEN FOSTER AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1457
Mailing Address - Country:US
Mailing Address - Phone:502-348-1155
Mailing Address - Fax:502-348-3277
Practice Address - Street 1:120 W STEPHEN FOSTER AVE STE 107
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1457
Practice Address - Country:US
Practice Address - Phone:502-348-1155
Practice Address - Fax:502-348-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64070992Medicaid
KY000000113034OtherBLUE CROSS
KY60070992Medicaid
KYU32951Medicare UPIN