Provider Demographics
NPI:1669288767
Name:ROMO DENTAL III PLLC
Entity type:Organization
Organization Name:ROMO DENTAL III PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENARO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-656-2441
Mailing Address - Street 1:5217 W 109TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-6340
Mailing Address - Country:US
Mailing Address - Phone:773-519-1022
Mailing Address - Fax:
Practice Address - Street 1:5934 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4167
Practice Address - Country:US
Practice Address - Phone:708-656-2441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental