Healthcare Provider Details

I. General information

NPI: 1003521543
Provider Name (Legal Business Name): ROMAO TORMENA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5491 DOLPHIN POINT BLVD
JACKSONVILLE FL
32211-3221
US

IV. Provider business mailing address

2800 UNIVERSITY BLVD N
JACKSONVILLE FL
32211-3321
US

V. Phone/Fax

Practice location:
  • Phone: 904-256-7854
  • Fax:
Mailing address:
  • Phone: 904-256-7854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDTP777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: