Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 7099 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 7099 | KY |
NPI | 1538150016 |
---|---|
Provider Name | Dr. Romeo Nantes Laureano |
First Address | Bardstown, KY 40004 |
Second Address | Bardstown, KY 40004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000113034 | BLUE CROSS (01) | KY |
60070992 | (05) | KY |
64070998 | (05) | KY |
U32951 | (02) |