Provider Demographics
NPI:1255460911
Name:ORLANDO DOMINGUEZ, DMD, PA
Entity type:Organization
Organization Name:ORLANDO DOMINGUEZ, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-386-2766
Mailing Address - Street 1:9280 HAMMOCKS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1594
Mailing Address - Country:US
Mailing Address - Phone:305-386-2766
Mailing Address - Fax:305-386-3318
Practice Address - Street 1:9280 HAMMOCKS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1594
Practice Address - Country:US
Practice Address - Phone:305-386-2766
Practice Address - Fax:305-386-3318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 80011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty