Healthcare Provider Details

I. General information

NPI: 1972823029
Provider Name (Legal Business Name): GREGORY ROMNEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GREG ROMNEY DMD

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6755 E SUPERSTITION SPRINGS BLVD STE 103
MESA AZ
85206-4375
US

IV. Provider business mailing address

6755 E SUPERSTITION SPRINGS BLVD STE 103
MESA AZ
85206-4375
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-5866
  • Fax: 480-807-0606
Mailing address:
  • Phone: 480-830-5866
  • Fax: 480-807-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD008059
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: