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General NPI Number Information
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NPI Number | 1255460911
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Entity Type | Organization
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Legal Business Name | ORLANDO DOMINGUEZ, DMD, PA
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 9280 HAMMOCKS BLVD SUITE 104
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City | MIAMI
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State | FL
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Zip | 33196-1594
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Country | US
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Telephone | 305-386-2766
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Fax | 305-386-3318
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Provider Business Mailing Address
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Address Line | 9280 HAMMOCKS BLVD SUITE 104
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City | MIAMI
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State | FL
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Zip | 33196-1594
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Country | US
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Telephone | 305-386-2766
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Fax | 305-386-3318
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ORLANDO DOMINGUEZ
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Credential | D.M.D.
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Telephone | 305-386-2766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN 8001
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License Number State | FL
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