Provider Demographics
NPI:1811978471
Name:ROMO, GENARO JR
Entity type:Individual
Prefix:DR
First Name:GENARO
Middle Name:
Last Name:ROMO
Suffix:JR
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 1:4146 S ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-1825
Mailing Address - Country:US
Mailing Address - Phone:773-247-3345
Mailing Address - Fax:773-927-3862
Practice Address - Street 1:4146 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-1825
Practice Address - Country:US
Practice Address - Phone:773-247-3345
Practice Address - Fax:773-927-3862
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice