Provider Demographics
NPI:1790865491
Name:ROMERO, JUAN CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:ROMERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:C
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:27830 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2239
Mailing Address - Country:US
Mailing Address - Phone:951-679-5313
Mailing Address - Fax:951-679-6344
Practice Address - Street 1:27830 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2239
Practice Address - Country:US
Practice Address - Phone:951-679-5313
Practice Address - Fax:951-679-6344
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice