Provider Demographics
NPI:1982614582
Name:ROMAN, JOSE ANGEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANGEL
Last Name:ROMAN
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 1:909 CALLE ALAMEDA
Mailing Address - Street 2:VILLA GRANADA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-2719
Mailing Address - Country:US
Mailing Address - Phone:787-999-6973
Mailing Address - Fax:787-999-6973
Practice Address - Street 1:# 349 FELISA RINCON AVE.
Practice Address - Street 2:SUITE # 205
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-999-6973
Practice Address - Fax:787-999-6973
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR961-1000OtherHUMANA
PR1000-06OtherCRUZ AZUL
PR41860OtherSSS