Provider Demographics
NPI:1558370601
Name:DOMINGUEZ, MERCEDES SIMONE (DDS,MS,PA)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:SIMONE
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:DDS,MS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 STATE HIGHWAY 161
Mailing Address - Street 2:SUITE 215
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2804
Mailing Address - Country:US
Mailing Address - Phone:972-556-2100
Mailing Address - Fax:972-556-2112
Practice Address - Street 1:7200 STATE HIGHWAY 161
Practice Address - Street 2:SUITE 215
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2804
Practice Address - Country:US
Practice Address - Phone:972-556-2100
Practice Address - Fax:972-556-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics