# JOHN M DOMANICO, D.D.S., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508262544
- **Authorized official:** DR. JOHN M DOMANICO D.D.S. (OWNER)
- **Authorized official phone:** (312) 629-3530

## Contact information

- **Practice address:** 30 N MICHIGAN AVE, SUITE522, CHICAGO, IL 60602-3402
- **Practice address phone:** (312) 629-3530
- **Practice address fax:** (312) 629-3516
- **Mailing address:** 30 N MICHIGAN AVE, SUITE522, CHICAGO, IL 60602-3402
- **Mailing address phone:** (312) 629-3530
- **Mailing address fax:** (312) 629-3516

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 11/18/2014
- **Last updated:** 11/18/2014