Provider Demographics
NPI:1275859712
Name:INOCENCIO, ROMULO LUARCA
Entity Type:Individual
Prefix:
First Name:ROMULO
Middle Name:LUARCA
Last Name:INOCENCIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6044 MLK JR WAY S STE 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-3179
Mailing Address - Country:US
Mailing Address - Phone:206-760-9571
Mailing Address - Fax:206-760-9627
Practice Address - Street 1:6044 MLK JR WAY S
Practice Address - Street 2:STE #101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118
Practice Address - Country:US
Practice Address - Phone:206-760-9571
Practice Address - Fax:206-760-9627
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000031122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist