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General NPI Number Information
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NPI Number | 1073800520
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Entity Type | Individual
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Provider Name | DOMINIC MOREL-MAYNARD D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2011
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 15340 S JOG RD STE 100
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City | DELRAY BEACH
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State | FL
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Zip | 33446-2170
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Country | US
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Telephone | 561-495-2099
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Fax |
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Provider Business Mailing Address
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Address Line | 5720 FOX HOLLOW DR APT C
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City | BOCA RATON
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State | FL
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Zip | 33486-8928
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Country | US
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Telephone | 917-703-8220
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN 21761
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN21761
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 2018010876
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License Number State | MO
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