MEDICARE: WILDER ADOLFO ROMERO MORALES DDS

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
1	1223G0001X	General Practice Dentistry	112563	CA

General Provider Information

NPI Number	:	1093671752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILDER ADOLFO ROMERO MORALES DDS

Provider Business Mailing Address
First Line	:	310 JACK LONDON AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-3171
Country	:	US
Telephone Number	:	713-822-4490
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 JACK LONDON AVE
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-3171
Country	:	US
Telephone Number	:	713-822-4490
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/31/2025

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