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General NPI Number Information
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NPI Number | 1154426716
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Entity Type | Individual
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Provider Name | DENNIS N. DOMATO D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12613 TAYLORSVILLE RD SUITE 117
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City | LOUISVILLE
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State | KY
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Zip | 40299-4452
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Country | US
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Telephone | 502-266-5355
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Fax |
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Provider Business Mailing Address
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Address Line | 9529 NORTON COMMONS BLVD
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City | PROSPECT
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State | KY
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Zip | 40059-7521
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Country | US
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Telephone | 502-425-1565
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 8069
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License Number State | KY
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