Healthcare Provider Details

I. General information

NPI: 1346703568
Provider Name (Legal Business Name): JORGE ROMERO D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JORGE ANTONIO ROMERO D.M.D

II. Dates (important events)

Enumeration Date: 04/14/2019
Last Update Date: 08/12/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6075 POPLAR AVE STE 111
MEMPHIS TN
38119-4740
US

IV. Provider business mailing address

6631 W 14TH AVE
HIALEAH FL
33012-6238
US

V. Phone/Fax

Practice location:
  • Phone: 901-236-0648
  • Fax:
Mailing address:
  • Phone: 786-277-3365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12791
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: