Provider Demographics
NPI:1457706590
Name:DOMINGUEZ CRESPO, IVETTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:DOMINGUEZ CRESPO
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 1:15818 SOUTH FWY STE 140
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1821
Mailing Address - Country:US
Mailing Address - Phone:832-810-8485
Mailing Address - Fax:713-352-2985
Practice Address - Street 1:15818 SOUTH FWY STE 140
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1821
Practice Address - Country:US
Practice Address - Phone:832-810-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX328251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32825OtherTEXAS LICENSE