Provider Demographics
NPI:1164766168
Name:ROMERO, MIRELLE S (DDS)
Entity type:Individual
Prefix:
First Name:MIRELLE
Middle Name:S
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 1:508 N 10TH ST STE C3
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4583
Mailing Address - Country:US
Mailing Address - Phone:956-631-5481
Mailing Address - Fax:956-618-1776
Practice Address - Street 1:508 N 10TH ST STE C3
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4583
Practice Address - Country:US
Practice Address - Phone:956-631-5481
Practice Address - Fax:956-618-1776
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28422122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist