Provider Demographics
NPI:1073540936
Name:ROMER, JON PRESTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:PRESTON
Last Name:ROMER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 HWY 35 NORTH,STE#C
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:TX
Mailing Address - Zip Code:78382-3328
Mailing Address - Country:US
Mailing Address - Phone:361-790-9200
Mailing Address - Fax:
Practice Address - Street 1:1406 HIGHWAY 35 N
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:TX
Practice Address - Zip Code:78382-3329
Practice Address - Country:US
Practice Address - Phone:361-790-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist