Provider Demographics
NPI:1225250822
Name:DOMINY, WILBURN TAYLOR JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILBURN
Middle Name:TAYLOR
Last Name:DOMINY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 SHAKERAG HL
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3367
Mailing Address - Country:US
Mailing Address - Phone:770-631-0044
Mailing Address - Fax:770-631-9434
Practice Address - Street 1:5000 SHAKERAG HL
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3367
Practice Address - Country:US
Practice Address - Phone:770-631-0044
Practice Address - Fax:770-631-9434
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0108881223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics