Provider Demographics
NPI:1821583063
Name:DOMINGUEZ, DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:DOMINGUEZ
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 1:935 N WILCREST DR APT 4079
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-3578
Mailing Address - Country:US
Mailing Address - Phone:210-816-1956
Mailing Address - Fax:
Practice Address - Street 1:150 W PARKER RD STE 702
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-2940
Practice Address - Country:US
Practice Address - Phone:713-244-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist