Provider Demographics
NPI:1861832909
Name:ROMERO, JENNIFER GRIFFIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GRIFFIN
Last Name:ROMERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 OFFICE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1202 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5267
Practice Address - Country:US
Practice Address - Phone:662-513-0055
Practice Address - Fax:662-513-5376
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3733-14122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist