Provider Demographics
NPI:1073605846
Name:ADDONIZIO, DOMINICK J I (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:J
Last Name:ADDONIZIO
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-796-7546
Mailing Address - Fax:702-869-6146
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-450-7546
Practice Address - Fax:702-869-6146
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9088207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVC46624Medicare UPIN
NVV103548Medicare PIN