Provider Demographics
NPI:1376679407
Name:DOMINGO-NGUYEN, CATHLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:
Last Name:DOMINGO-NGUYEN
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 1:473 ENCINITAS BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3729
Mailing Address - Country:US
Mailing Address - Phone:760-634-2024
Mailing Address - Fax:760-634-7970
Practice Address - Street 1:473 ENCINITAS BLVD
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3729
Practice Address - Country:US
Practice Address - Phone:760-634-2024
Practice Address - Fax:760-634-7970
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA433331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice