Provider Demographics
NPI:1154449395
Name:AQUINO, ROMEO REYES (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:REYES
Last Name:AQUINO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 FRANKLIN ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612
Mailing Address - Country:US
Mailing Address - Phone:510-834-6511
Mailing Address - Fax:510-834-6511
Practice Address - Street 1:1624 FRANKLIN ST
Practice Address - Street 2:SUITE 405
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612
Practice Address - Country:US
Practice Address - Phone:510-834-6511
Practice Address - Fax:510-834-6511
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3974801Medicare ID - Type UnspecifiedDENTI CAL