Provider Demographics
NPI:1427291277
Name:DOMINGO, DEMETRIO LABSO (DDS)
Entity type:Individual
Prefix:DR
First Name:DEMETRIO
Middle Name:LABSO
Last Name:DOMINGO
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 1:1701 16TH ST NW
Mailing Address - Street 2:217
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3145
Mailing Address - Country:US
Mailing Address - Phone:301-402-1706
Mailing Address - Fax:301-480-4455
Practice Address - Street 1:1701 16TH ST NW
Practice Address - Street 2:217
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-3145
Practice Address - Country:US
Practice Address - Phone:202-714-8727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41827122300000X
DCDEN1000553122300000X
NY051929-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist