Provider Demographics
NPI:1427783729
Name:ROMERO, NICOLE (DMD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ROMERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2716 KILDRUMMIE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-0235
Mailing Address - Country:US
Mailing Address - Phone:561-926-0517
Mailing Address - Fax:
Practice Address - Street 1:3519 SAINT ROSE PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4598
Practice Address - Country:US
Practice Address - Phone:561-926-0517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV76981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice