Provider Demographics
NPI:1083339477
Name:DOMINGUEZ, MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 SW 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4467
Mailing Address - Country:US
Mailing Address - Phone:786-838-3136
Mailing Address - Fax:
Practice Address - Street 1:7244 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-5441
Practice Address - Country:US
Practice Address - Phone:954-341-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL274661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice