Provider Demographics
NPI:1336833698
Name:DOMINICIS, JORGE OSCAR (DDS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:OSCAR
Last Name:DOMINICIS
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 1:7660 COOLGROVE DR
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-2626
Mailing Address - Country:US
Mailing Address - Phone:562-367-5807
Mailing Address - Fax:
Practice Address - Street 1:8202 FLORENCE AVE STE 101
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3937
Practice Address - Country:US
Practice Address - Phone:562-861-8807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108489122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist