Provider Demographics
NPI:1710036009
Name:DOMINGO, MICHAEL IRUGUIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:IRUGUIN
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 1:15444 W COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7719
Mailing Address - Country:US
Mailing Address - Phone:623-535-5056
Mailing Address - Fax:
Practice Address - Street 1:15444 W COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7719
Practice Address - Country:US
Practice Address - Phone:623-535-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0513221223G0001X
AZD72001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice