Dominguez Family Dental, Csp

NPI #1023713740 in Guayama, Puerto Rico

Provider Information

NPI Number: 1023713740
Entity Type: Organization
Organization Name: Dominguez Family Dental, Csp
Primary Specialty: Dentist - General Practice
Enumeration Date: Apr 3, 2023
Last Updated: Jun 15, 2023

Practice Location

Address: CALLE SANTIAGO PALMER 24 SUR
Address 2: N/A
City: Guayama
State: Puerto Rico
ZIP Code: 00784
Phone: (787) 866-3631

Authorized Official

Name: DR. IVELISSE DOMINGUEZ REVERON, DMD
Title: PRESIDENT
Phone: (787) 678-7806

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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