Provider Demographics
NPI:1932273489
Name:DOMPKOWSKI, DOUGLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:DOMPKOWSKI
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 1:5411 W CEDAR LN
Mailing Address - Street 2:SUITE# 206-A
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1516
Mailing Address - Country:US
Mailing Address - Phone:301-530-5858
Mailing Address - Fax:
Practice Address - Street 1:5411 W CEDAR LN
Practice Address - Street 2:SUITE# 206-A
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1516
Practice Address - Country:US
Practice Address - Phone:301-530-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD117911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics