Provider Demographics
NPI:1659322725
Name:DOMINGO, ERWIN JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:ERWIN
Middle Name:JOSEPH
Last Name:DOMINGO
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 1:20 CUMBERLAND HILL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4854
Mailing Address - Country:US
Mailing Address - Phone:401-769-1200
Mailing Address - Fax:401-769-1204
Practice Address - Street 1:20 CUMBERLAND HILL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4854
Practice Address - Country:US
Practice Address - Phone:401-769-1200
Practice Address - Fax:401-769-1204
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI27361223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4007Medicare ID - Type Unspecified