MEDICARE: JOHN M. ROMULUS DDS PA

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	122300000X	Dentist	5368	NC

General Provider Information

NPI Number	:	1871953554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN M. ROMULUS DDS PA

Provider Business Mailing Address
First Line	:	3301 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5231
Country	:	US
Telephone Number	:	910-938-4333
Fax Number	:	910-938-2889

Provider Business Practice Location Address
First Line	:	3301 HENDERSON DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-5231
Country	:	US
Telephone Number	:	910-938-4333
Fax Number	:	910-938-2889

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DEBORAH LEE
Credential	:
Telephone Number	:	910-938-4333

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	02/24/2016

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