=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427263722
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROENA URIARTE ROMERO DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
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 |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS038048
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------