Provider Demographics
NPI:1689396145
Name:ROMERO, MARTIN SR (DMD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:ROMERO
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S WATSON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-3435
Mailing Address - Country:US
Mailing Address - Phone:623-386-7319
Mailing Address - Fax:
Practice Address - Street 1:825 S WATSON RD STE 101
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3435
Practice Address - Country:US
Practice Address - Phone:623-386-7319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0115721223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health