Healthcare Provider Details

I. General information

NPI: 1821159229
Provider Name (Legal Business Name): CRISTINA DOMINGUEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9192 GLADES RD STE B
BOCA RATON FL
33434-3912
US

IV. Provider business mailing address

PO BOX 3189
SYRACUSE NY
13220-3189
US

V. Phone/Fax

Practice location:
  • Phone: 561-576-9086
  • Fax:
Mailing address:
  • Phone: 315-454-6000
  • Fax: 315-454-8650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17518
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: