Provider Demographics
NPI:1184076291
Name:LOMBARDI, DOMENIC GERALD (DMD)
Entity type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:GERALD
Last Name:LOMBARDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 WINTERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44403-9625
Mailing Address - Country:US
Mailing Address - Phone:330-565-3538
Mailing Address - Fax:
Practice Address - Street 1:60 N MERCER AVE
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150-2244
Practice Address - Country:US
Practice Address - Phone:330-565-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0409221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice