Provider Demographics
NPI:1720095201
Name:ROMULUS, JOHN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:ROMULUS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:M
Other - Last Name:ROMULUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:306 DOLPHIN DR STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5266
Mailing Address - Country:US
Mailing Address - Phone:910-455-3686
Mailing Address - Fax:910-455-6394
Practice Address - Street 1:306 DOLPHIN DR STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5266
Practice Address - Country:US
Practice Address - Phone:910-455-3686
Practice Address - Fax:910-455-6394
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC56-2245313OtherEIN