Provider Demographics
NPI:1275640989
Name:DOMINGUEZ, ANA BEATRIZ (DDS)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:BEATRIZ
Last Name:DOMINGUEZ
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 1:290 LANDIS AVE
Mailing Address - Street 2:SUITE A & B
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2636
Mailing Address - Country:US
Mailing Address - Phone:619-691-0121
Mailing Address - Fax:619-691-0841
Practice Address - Street 1:290 LANDIS AVE
Practice Address - Street 2:SUITE A & B
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2636
Practice Address - Country:US
Practice Address - Phone:619-691-0121
Practice Address - Fax:619-691-0841
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice