Provider Demographics
NPI:1508833229
Name:DOMINGUEZ, BUENA (DMD,MS)
Entity Type:Individual
Prefix:DR
First Name:BUENA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:DMD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4291 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-4051
Mailing Address - Country:US
Mailing Address - Phone:989-793-7241
Mailing Address - Fax:989-793-0254
Practice Address - Street 1:4291 STATE ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-4051
Practice Address - Country:US
Practice Address - Phone:989-793-7241
Practice Address - Fax:989-793-0254
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0152861223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics