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NPI Code Detail

MEDICARE: DR. LILIAN Z DOMINGUEZ D.D.S

MEDICARE:  DR. LILIAN Z DOMINGUEZ  D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist44164CA

General Provider Information

NPI Number : 1659586261
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LILIAN Z DOMINGUEZ D.D.S
Provider Business Mailing Address
First Line : 6489 EDMONTON AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92122
Country : US
Telephone Number : 858-455-7343
Fax Number :
Provider Business Practice Location Address
First Line : 2939 ALTA VIEW DR STE A
Second Line :
City : SAN DIEGO
State : CA
Zip : 92139-3394
Country : US
Telephone Number : 619-267-8772
Fax Number : 619-475-6099
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2007
Last Update Date : 07/08/2007

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Directions to “ DR. LILIAN Z DOMINGUEZ D.D.S” Practice Location

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