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NPI Code Detail

MEDICARE: DR. JUAN SEBASTIAN LARA ROMERO DDS, MSC, PHD

MEDICARE: DR. JUAN SEBASTIAN LARA ROMERO DDS, MSC, PHD
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
1122300000XDentistLDF260038IN

General Provider Information

NPI Number : 1124972096
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUAN SEBASTIAN LARA ROMERO DDS, MSC, PHD
Provider Business Mailing Address
First Line : 1140 W MICHIGAN ST STE 326E
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5209
Country : US
Telephone Number : 317-274-5463
Fax Number :
Provider Business Practice Location Address
First Line : 1121 W MICHIGAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5211
Country : US
Telephone Number : 317-274-5463
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2026
Last Update Date : 03/10/2026

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