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General NPI Number Information
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NPI Number | 1710036009
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Entity Type | Individual
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Provider Name | MICHAEL IRUGUIN DOMINGO DDS
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 15444 W COOLIDGE ST
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City | GOODYEAR
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State | AZ
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Zip | 85395-7719
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Country | US
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Telephone | 623-535-5056
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Fax |
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Provider Business Mailing Address
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Address Line | 15444 W COOLIDGE ST
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City | GOODYEAR
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State | AZ
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Zip | 85395-7719
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Country | US
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Telephone | 623-535-5056
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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 | 051322
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D7200
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License Number State | AZ
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