MEDICARE: CLARA LUCIA NUNEZ-ROMERO, DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	9221	NC
2	122300000X	Dentist	9221	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245574318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARA LUCIA NUNEZ-ROMERO, DDS PLLC

Provider Business Mailing Address
First Line	:	2331 CROWNPOINT EXECUTIVE DR STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7749
Country	:	US
Telephone Number	:	704-705-4744
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 CROWNPOINT EXECUTIVE DR STE A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7749
Country	:	US
Telephone Number	:	704-705-4744
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. CLARA LUCIA NUNEZ-ROMERO
Credential	:	DDS
Telephone Number	:	704-497-5834

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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