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General NPI Number Information
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NPI Number | 1750196176
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Entity Type | Individual
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Provider Name | DEBORAH KAY DOMEN R.D.H.
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | NAVAL HOSPITAL 2080 CHILD ST DEPT 5000
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City | JACKSONVILLE
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State | FL
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Zip | 32214-0001
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Country | US
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Telephone | 912-573-4212
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Fax |
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Provider Business Mailing Address
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Address Line | 97182 HARBOR CONCOURSE CIR
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3873
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Country | US
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Telephone | 910-526-2333
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH043616
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 9243
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH31087
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License Number State | FL
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