Provider Demographics
NPI:1811587504
Name:DOMINO DENTAL
Entity Type:Organization
Organization Name:DOMINO DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELHACHMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-762-0454
Mailing Address - Street 1:121 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-5504
Mailing Address - Country:US
Mailing Address - Phone:347-762-0454
Mailing Address - Fax:
Practice Address - Street 1:121 S 4TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-5504
Practice Address - Country:US
Practice Address - Phone:347-762-0454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-26
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty