Healthcare Provider Details

I. General information

NPI: 1316851306
Provider Name (Legal Business Name): DOMINICK LUIGI FIERRO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43000 MIDWAY AVE
SAN DIEGO CA
92140-5692
US

IV. Provider business mailing address

2621 W CANYON AVE APT 421
SAN DIEGO CA
92123-4698
US

V. Phone/Fax

Practice location:
  • Phone: 619-524-4005
  • Fax:
Mailing address:
  • Phone: 619-524-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number42426
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: