Provider Demographics
NPI:1174576367
Name:ROMAN, ELISEO (DMD)
Entity type:Individual
Prefix:DR
First Name:ELISEO
Middle Name:
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:PO BOX 924
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-0924
Mailing Address - Country:US
Mailing Address - Phone:787-299-9377
Mailing Address - Fax:787-869-5333
Practice Address - Street 1:ROAD 164 RAMAL KM. 0.2
Practice Address - Street 2:BOX 924
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-0924
Practice Address - Country:US
Practice Address - Phone:787-299-9377
Practice Address - Fax:787-869-5333
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist