Provider Demographics
NPI:1568639268
Name:ABREU, ROMELIO R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROMELIO
Middle Name:R
Last Name:ABREU
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 1:3425 BANNERMAN RD STE 105-138
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-7062
Mailing Address - Country:US
Mailing Address - Phone:850-727-5773
Mailing Address - Fax:
Practice Address - Street 1:2418 MILLCREEK LANE
Practice Address - Street 2:SUITE 3
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-727-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL156161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112219500Medicaid