Provider Demographics
NPI:1124386925
Name:ROMERO MORRELL, MARIBEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
Last Name:ROMERO MORRELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 S 11TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6968
Mailing Address - Country:US
Mailing Address - Phone:208-342-3440
Mailing Address - Fax:208-336-4740
Practice Address - Street 1:403 S 11TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6968
Practice Address - Country:US
Practice Address - Phone:208-342-3440
Practice Address - Fax:208-336-4740
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD2036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist