Provider Demographics
NPI:1588322028
Name:DOMINGUEZ, CARLEMI J (RDH)
Entity type:Individual
Prefix:
First Name:CARLEMI
Middle Name:J
Last Name:DOMINGUEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CARLEMI
Other - Middle Name:J
Other - Last Name:DOMINGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:225 E 118TH ST APT 707
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-4384
Mailing Address - Country:US
Mailing Address - Phone:646-696-6822
Mailing Address - Fax:
Practice Address - Street 1:470 LENOX AVE APT 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-3012
Practice Address - Country:US
Practice Address - Phone:212-283-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030445-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist