Provider Demographics
NPI:1407061112
Name:ROMERO, RONALD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:ROMERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RON
Other - Middle Name:
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:202 AVENIDA VISTA GRANDE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-9150
Mailing Address - Country:US
Mailing Address - Phone:505-466-4140
Mailing Address - Fax:
Practice Address - Street 1:202 AVENIDA VISTA GRANDE
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-9150
Practice Address - Country:US
Practice Address - Phone:505-466-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMD1253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist