Provider Demographics
NPI:1114953494
Name:DOMINICI-BLY, LIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIA
Middle Name:
Last Name:DOMINICI-BLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LIA
Other - Middle Name:
Other - Last Name:BLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2732 E MANOA RD
Mailing Address - Street 2:#A
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1818
Mailing Address - Country:US
Mailing Address - Phone:808-729-6107
Mailing Address - Fax:
Practice Address - Street 1:6700 KALANIANAOLE HWY
Practice Address - Street 2:SUITE 107
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1277
Practice Address - Country:US
Practice Address - Phone:808-396-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT17221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56419OtherDENTAL LICENSE
HIDT 1722OtherDENTAL LICENSE