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NPI Code Detail

MEDICARE: ROMO DENTAL, PC

MEDICARE: ROMO DENTAL, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073656922
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROMO DENTAL, PC
Provider Business Mailing Address
First Line : 4148 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-1825
Country : US
Telephone Number : 773-247-3345
Fax Number :
Provider Business Practice Location Address
First Line : 4148 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-1825
Country : US
Telephone Number : 773-247-3345
Fax Number :
Authorized Official
Title or Position : D.D.S.
Name : DR. GENARO ROMO JR.
Credential :
Telephone Number : 773-247-3345
Provider Enumeration Date : 02/14/2007
Last Update Date : 11/30/2010

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1851885453 — DR. MELISSA VILLAFANE DMD
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60632-1825
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