Provider Demographics
NPI:1821725839
Name:BERTUCCI, DOMINIQUE ERICA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:ERICA
Last Name:BERTUCCI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 JOLIET ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-3434
Mailing Address - Country:US
Mailing Address - Phone:312-607-1029
Mailing Address - Fax:
Practice Address - Street 1:860 POTOMAC CIR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6714
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program