Provider Demographics
NPI:1144643347
Name:CLARA LUCIA NUNEZ-ROMERO, DDS PLLC
Entity type:Organization
Organization Name:CLARA LUCIA NUNEZ-ROMERO, DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:NUNEZ-ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-705-4744
Mailing Address - Street 1:2331 CROWNPOINT EXECUTIVE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7825
Mailing Address - Country:US
Mailing Address - Phone:704-705-4744
Mailing Address - Fax:980-339-8524
Practice Address - Street 1:2331 CROWNPOINT EXECUTIVE DR
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7825
Practice Address - Country:US
Practice Address - Phone:704-705-4744
Practice Address - Fax:980-339-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9221261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1073808259Medicaid
NC1811285349Medicaid
NC1942596788Medicaid