Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2331 CROWNPOINT EXECUTIVE DR STE A
CHARLOTTE NC
28227-7749
US

IV. Provider business mailing address

2331 CROWNPOINT EXECUTIVE DR STE A
CHARLOTTE NC
28227-7749
US

V. Phone/Fax

Practice location:
  • Phone: 704-705-4744
  • Fax:
Mailing address:
  • Phone: 704-705-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9221
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number9221
License Number StateNC

VIII. Authorized Official

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