1023001831 NPI number — DR. IVAN ROMAN DDS

Table of content: DR. IVAN ROMAN DDS (NPI 1023001831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023001831 NPI number — DR. IVAN ROMAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROMAN
Provider First Name:
IVAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023001831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3259 CATLIN AVE
Provider Second Line Business Mailing Address:
NAVAL HEALTH CLINIC QUANTICO
Provider Business Mailing Address City Name:
QUANTICO
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-784-2802
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 482 BOX 1600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96362-0017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
98-971-9355
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  40114 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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