Basic Information
| Provider Information | |||||||||
| NPI: | 1265559603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOMINICIS | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | RAMIRO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8202 FLORENCE AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902403937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628618807 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8202 FLORENCE AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902403937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628618807 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 40805 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.