Provider Demographics
NPI:1497426183
Name:ROMANS, NICHOLAS ROBERT (DMD, MSD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ROBERT
Last Name:ROMANS
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 E WALTANN LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1945
Mailing Address - Country:US
Mailing Address - Phone:620-205-9494
Mailing Address - Fax:
Practice Address - Street 1:21083 N JOHN WAYNE PKWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-2959
Practice Address - Country:US
Practice Address - Phone:623-343-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012045122300000X, 1223X0400X
MADN1859192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics