Provider Demographics
NPI:1801345210
Name:JEREZ ROMERO, LUIS ENRIQUE (DDS)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:JEREZ ROMERO
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 1:1270 E LELAND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5347
Mailing Address - Country:US
Mailing Address - Phone:925-427-2222
Mailing Address - Fax:
Practice Address - Street 1:1270 E LELAND RD STE 101
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5347
Practice Address - Country:US
Practice Address - Phone:925-427-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1001031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice