=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144643347
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLARA LUCIA NUNEZ-ROMERO, DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2014
-----------------------------------------------------
Last Update Date | 01/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2331 CROWNPOINT EXECUTIVE DR SUITE A
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28227-7825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-705-4744
-----------------------------------------------------
Fax | 980-339-8524
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2331 CROWNPOINT EXECUTIVE DR SUITE A
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28227-7825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-705-4744
-----------------------------------------------------
Fax | 980-339-8524
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/DENTIST
-----------------------------------------------------
Name | CLARA LUCIA NUNEZ-ROMERO
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 704-705-4744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 9221
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------