Provider Demographics
NPI:1780794917
Name:DOMINGUEZ, DAVID JAIME (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JAIME
Last Name:DOMINGUEZ
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 1:17240 MILL FOREST RD
Mailing Address - Street 2:STE A
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:281-280-9149
Mailing Address - Fax:281-280-0732
Practice Address - Street 1:17240 MILL FOREST RD
Practice Address - Street 2:STE A
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-280-9149
Practice Address - Fax:281-280-0732
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0147461223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics