Healthcare Provider Details

I. General information

NPI: 1093671752
Provider Name (Legal Business Name): WILDER ADOLFO ROMERO MORALES DDS
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: ADOLFO ROMERO DDS

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 JACK LONDON AVE
ALAMEDA CA
94501-3171
US

IV. Provider business mailing address

310 JACK LONDON AVE
ALAMEDA CA
94501-3171
US

V. Phone/Fax

Practice location:
  • Phone: 713-822-4490
  • Fax:
Mailing address:
  • Phone: 713-822-4490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: