Provider Demographics
NPI:1790947604
Name:ROMACK, DEBORAH A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:A
Last Name:ROMACK
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 1:114 W COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4312
Mailing Address - Country:US
Mailing Address - Phone:817-594-3806
Mailing Address - Fax:
Practice Address - Street 1:114 W COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4312
Practice Address - Country:US
Practice Address - Phone:817-594-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193421223G0001X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1223G0001XDental ProvidersDentistGeneral Practice