Provider Demographics
NPI:1043556202
Name:ROMINE, ANGELA BEVIN
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:BEVIN
Last Name:ROMINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GLOVER LN
Mailing Address - Street 2:
Mailing Address - City:DORA
Mailing Address - State:AL
Mailing Address - Zip Code:35062-4006
Mailing Address - Country:US
Mailing Address - Phone:205-522-3238
Mailing Address - Fax:
Practice Address - Street 1:95 GLOVER LN
Practice Address - Street 2:
Practice Address - City:DORA
Practice Address - State:AL
Practice Address - Zip Code:35062-4006
Practice Address - Country:US
Practice Address - Phone:205-522-3238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant