Provider Demographics
NPI:1003173162
Name:DOMINGO, ESTER LISA PENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ESTER LISA
Middle Name:PENA
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 PIMLICO DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3485
Mailing Address - Country:US
Mailing Address - Phone:925-224-9800
Mailing Address - Fax:925-224-9907
Practice Address - Street 1:4040 PIMLICO DR
Practice Address - Street 2:SUITE 120
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3485
Practice Address - Country:US
Practice Address - Phone:925-224-9800
Practice Address - Fax:925-224-9907
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42464122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist