Provider Demographics
NPI:1184869919
Name:DOMI, DASHAMIR (RDH)
Entity type:Individual
Prefix:MR
First Name:DASHAMIR
Middle Name:
Last Name:DOMI
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 INTERNATIONAL CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3127
Mailing Address - Country:US
Mailing Address - Phone:719-632-5700
Mailing Address - Fax:
Practice Address - Street 1:2225 MISSION ST SE
Practice Address - Street 2:SUITE 150
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1297
Practice Address - Country:US
Practice Address - Phone:503-881-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.002026584124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist