Provider Demographics
NPI:1427384007
Name:SAMUEL C. ROMBAOA DDS INC
Entity type:Organization
Organization Name:SAMUEL C. ROMBAOA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROMBAOA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-227-5309
Mailing Address - Street 1:125 E BARSTOW AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5020
Mailing Address - Country:US
Mailing Address - Phone:559-227-5309
Mailing Address - Fax:559-227-7934
Practice Address - Street 1:125 E BARSTOW AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5020
Practice Address - Country:US
Practice Address - Phone:559-227-5309
Practice Address - Fax:559-227-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental