Provider Demographics
NPI:1962731927
Name:MERCEDES S DOMINGUEZ, DDS, MS, PA
Entity type:Organization
Organization Name:MERCEDES S DOMINGUEZ, DDS, MS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:972-556-2100
Mailing Address - Street 1:7200 N HIGHWAY 161
Mailing Address - Street 2:SUITE 215
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4132
Mailing Address - Country:US
Mailing Address - Phone:972-556-2100
Mailing Address - Fax:972-556-2112
Practice Address - Street 1:7200 N HIGHWAY 161
Practice Address - Street 2:SUITE 215
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4132
Practice Address - Country:US
Practice Address - Phone:972-556-2100
Practice Address - Fax:972-556-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20568174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty