Healthcare Provider Details

I. General information

NPI: 1255504569
Provider Name (Legal Business Name): ANIBAL ROMERO, D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 WARREN ST
ELMHURST NY
11373-1700
US

IV. Provider business mailing address

4011 WARREN ST
ELMHURST NY
11373-1700
US

V. Phone/Fax

Practice location:
  • Phone: 718-426-3434
  • Fax: 718-426-2114
Mailing address:
  • Phone: 718-426-3434
  • Fax: 718-426-2114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number031386
License Number StateNY

VIII. Authorized Official

Name: DR. ANIBAL ROMERO
Title or Position: DENTIST
Credential: D.D.S.
Phone: 718-426-3434