Provider Demographics
NPI:1508837980
Name:DOMINGUEZ, JAIME SALAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:SALAS
Last Name:DOMINGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 K ST
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2737
Mailing Address - Country:US
Mailing Address - Phone:760-344-3583
Mailing Address - Fax:760-344-8480
Practice Address - Street 1:1166 K ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2737
Practice Address - Country:US
Practice Address - Phone:760-344-3583
Practice Address - Fax:760-344-8480
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA370971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice