Michael Gavin Romenesko, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6139-015 Issued in WI

Practice address

2510 E Evergreen Dr
Appleton, WI 54913-8904

Phone

(920) 739-7848

NPI assigned

Nov 2, 2007

Last updated

Nov 2, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• CM Romenesko DDS SC

  • Dental Clinic/Center
  • Appleton, WI
  • NPI 1558017459
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193961600000",
    "number": "1437338720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2510 E EVERGREEN DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138904",
            "telephone_number": "920-739-7848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2510 E EVERGREEN DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138904",
            "telephone_number": "920-739-7848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROMENESKO",
        "first_name": "MICHAEL",
        "middle_name": "GAVIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-02",
        "last_updated": "2007-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6139-015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esther Lea Rolfe, COTA
• Holly Ann Rolfs-Jandrt, LPC-IT
• Benjamin Joseph Romenesko, D.D.S.
• Jeffrey Gerald Romenesko, D.D.S.
• Kimberly A Romenesko, APNP
• Richard Lee Romenesko Sr., D.D.S.
• Bethany Romesser, LAT, PTA
• Ronald W Schauland, Crna, LLC
• Kristen M Rose, LCSW
• Simon Edwin Roselaar, MD

• General Practice Dentistry in Appleton, WI
• Providers in Appleton, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.