Provider Demographics
NPI:1659586261
Name:DOMINGUEZ, LILIAN Z (DDS)
Entity Type:Individual
Prefix:DR
First Name:LILIAN
Middle Name:Z
Last Name:DOMINGUEZ
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 1:6489 EDMONTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122
Mailing Address - Country:US
Mailing Address - Phone:858-455-7343
Mailing Address - Fax:
Practice Address - Street 1:2939 ALTA VIEW DR STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92139-3394
Practice Address - Country:US
Practice Address - Phone:619-267-8772
Practice Address - Fax:619-475-6099
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist