Provider Demographics
NPI:1942471883
Name:JOHN M ROMULUS DDS PA
Entity Type:Organization
Organization Name:JOHN M ROMULUS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:910-799-9699
Mailing Address - Street 1:3725 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4140
Mailing Address - Country:US
Mailing Address - Phone:910-799-9699
Mailing Address - Fax:910-792-9987
Practice Address - Street 1:3725 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4140
Practice Address - Country:US
Practice Address - Phone:910-799-9699
Practice Address - Fax:910-792-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997478Medicaid