=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033864095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROENA U ROMERO DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2022
-----------------------------------------------------
Last Update Date | 02/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 706 ALEXANDER RD
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-6302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-759-0019
-----------------------------------------------------
Fax | 609-216-7831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 706 ALEXANDER RD
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08540-6302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-759-0019
-----------------------------------------------------
Fax | 609-216-7831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. ROENA ROMERO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 609-759-0019
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------