Provider Demographics
NPI:1972717080
Name:ROMAC, NICHOLAS PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:PETER
Last Name:ROMAC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 PARK MARINA DR STE 19
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2158
Mailing Address - Country:US
Mailing Address - Phone:530-241-4304
Mailing Address - Fax:530-241-2052
Practice Address - Street 1:2301 PARK MARINA DR STE 19
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2158
Practice Address - Country:US
Practice Address - Phone:530-241-4304
Practice Address - Fax:530-241-2052
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33838122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist