Healthcare Provider Details

I. General information

NPI: 1336833698
Provider Name (Legal Business Name): JORGE OSCAR DOMINICIS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 06/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8202 FLORENCE AVE STE 101
DOWNEY CA
90240-3937
US

IV. Provider business mailing address

7660 COOLGROVE DR
DOWNEY CA
90240-2626
US

V. Phone/Fax

Practice location:
  • Phone: 562-861-8807
  • Fax:
Mailing address:
  • Phone: 562-367-5807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: