Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 000017 | NY |
NPI | 1144522590 |
---|---|
Provider Name | Georgios Romanos |
First Address | Rochester, NY 14620-2913 |
Second Address | Rochester, NY 14620-2913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2010 |
Last Update Date | 17/11/2010 |