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General NPI Number Information
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NPI Number | 1750525465
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Entity Type | Organization
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Legal Business Name | D & G DENTAL SERVICES PA
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 13171 CORTEZ BLVD
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City | BROOKSVILLE
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State | FL
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Zip | 34613
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Country | US
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Telephone | 352-296-1800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3189
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City | SYRACUSE
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State | NY
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Zip | 13220
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Country | US
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Telephone | 315-454-6000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CRISTINA DOMINQUEZ
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Credential | DMD
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Telephone | 352-296-1800
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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 | DN17518
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License Number State | FL
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