Basic Information
| Provider Information | |||||||||
| NPI: | 1720431315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANCHEZ DOMINGUEZ | ||||||||
| FirstName: | TANIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3501 E GORE BLVD APT 218 | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735016849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452703195 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6037 BESSINGER ST | ||||||||
| Address2: | |||||||||
| City: | FORT SILL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735034406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804426106 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2016 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DS040981 | PA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 22DI02653300 | NJ | Y | Dental Providers | Dentist | General Practice |
No ID Information.