Provider Demographics
NPI:1962210740
Name:ROMERO MORALES, ERIK STANLEY (DDS)
Entity type:Individual
Prefix:
First Name:ERIK STANLEY
Middle Name:
Last Name:ROMERO MORALES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 JACK LONDON AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3171
Mailing Address - Country:US
Mailing Address - Phone:510-872-0756
Mailing Address - Fax:
Practice Address - Street 1:2626 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3102
Practice Address - Country:US
Practice Address - Phone:415-285-9847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1110671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice