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General NPI Number Information
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NPI Number | 1336631084
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Entity Type | Individual
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Provider Name | CASEY DOMINGUEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 05/30/2018
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Last Update Date | 05/30/2018
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Provider Practice Location Address
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Address Line | 3920 W WALNUT ST
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City | ROGERS
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State | AR
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Zip | 72756-1809
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Country | US
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Telephone | 885-993-5543
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Fax |
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Provider Business Mailing Address
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Address Line | 6515 W PLEASANT WAY
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City | ROGERS
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State | AR
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Zip | 72758-8427
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Country | US
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Telephone | 972-415-9308
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4269
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License Number State | AR
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