Provider Demographics
NPI:1760092100
Name:ROMERO, MALENY (DDS)
Entity Type:Individual
Prefix:
First Name:MALENY
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14203 COUNTY ROAD 17
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-6551
Mailing Address - Country:US
Mailing Address - Phone:806-202-9452
Mailing Address - Fax:
Practice Address - Street 1:1331 W WILSON ST
Practice Address - Street 2:
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4421
Practice Address - Country:US
Practice Address - Phone:806-274-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX364541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice