Provider Demographics
NPI:1780886788
Name:ROUMAN, MARCO (BDS,MFDSRCS)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:
Last Name:ROUMAN
Suffix:
Gender:M
Credentials:BDS,MFDSRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26400 AMHEARST CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7582
Mailing Address - Country:US
Mailing Address - Phone:319-594-4377
Mailing Address - Fax:
Practice Address - Street 1:1690 ELM ST STE 300
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3679
Practice Address - Country:US
Practice Address - Phone:319-594-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08905122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist