Provider Demographics
NPI:1932669371
Name:ROMERO, YANISIS (DMD, CAGS, MSD)
Entity Type:Individual
Prefix:DR
First Name:YANISIS
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:DMD, CAGS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 JACKPINE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-6853
Mailing Address - Country:US
Mailing Address - Phone:305-699-7534
Mailing Address - Fax:
Practice Address - Street 1:4400 BAYOU BLVD STE 27
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2691
Practice Address - Country:US
Practice Address - Phone:850-476-5039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN219101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics