Doctor Name: | DR. ROBERT DOMINGUEZ |
NPI Number: | 1154339125 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DDS |
License Number: | 25510 |
Business Practice Address: | 750 N. Capitol Ave C-8 San Jose, CA - 95133 |
Business Phone Number: | 4089262221 |
Business Fax Number: | 4089268725 |
Mailing Address: | 750 N. Capitol Ave, C-8 SAN JOSE |
State: | CA |
Postal Code: | 95133 |
Phone Number: | 4089262221 |
Fax Number: | 4089268725 |
NPI Enumeration Date: | 08/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 25510 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |