Provider Demographics
NPI:1144348541
Name:ROMERO, TERESA DE JESUS (DDS)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:DE JESUS
Last Name:ROMERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6631 LAUREL CANYON BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1546
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6631 LAUREL CANYON BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1546
Practice Address - Country:US
Practice Address - Phone:818-765-6671
Practice Address - Fax:818-765-4340
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA033510122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3351001OtherMEDI CAL
CAB3351001OtherDENTI CAL