Healthcare Provider Details

I. General information

NPI: 1972807204
Provider Name (Legal Business Name): INGRID JOHANNA ROMERO D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13910 S JOG RD STE 103
DELRAY BEACH FL
33446-5908
US

IV. Provider business mailing address

2645 FILLMORE ST
HOLLYWOOD FL
33020-4327
US

V. Phone/Fax

Practice location:
  • Phone: 561-501-5759
  • Fax:
Mailing address:
  • Phone: 305-335-9535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN19252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: