Provider Demographics
NPI:1245574318
Name:CLARA LUCIA NUNEZ-ROMERO, DDS PLLC
Entity Type:Organization
Organization Name:CLARA LUCIA NUNEZ-ROMERO, DDS PLLC
Other - Org Name:DENTIST-SALUD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
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:704-497-5834
Mailing Address - Street 1:2331 CROWNPOINT EXECUTIVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-7749
Mailing Address - Country:US
Mailing Address - Phone:704-705-4744
Mailing Address - Fax:
Practice Address - Street 1:2331 CROWNPOINT EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-7749
Practice Address - Country:US
Practice Address - Phone:704-705-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9221122300000X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5919723Medicaid