Provider Demographics
NPI:1639297880
Name:BAUTISTA D, ROMEO SERRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROMEO
Middle Name:SERRA
Last Name:BAUTISTA D
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 1:34399 ALVARADO NILES RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4455
Mailing Address - Country:US
Mailing Address - Phone:510-477-0777
Mailing Address - Fax:510-477-0784
Practice Address - Street 1:34399 ALVARADO NILES RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-4455
Practice Address - Country:US
Practice Address - Phone:510-477-0777
Practice Address - Fax:510-477-0784
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA337241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice