Organization
DOMINGUEZ FAMILY DENTAL, CSP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IVELISSE DOMINGUEZ REVERON DMD (PRESIDENT)
(787) 678-7806
Entity
Organization
Contact information
Practice address
CALLE SANTIAGO PALMER 24 SUR, N/A, GUAYAMA, PR 00784
(787) 866-3631
(787) 866-8690
Mailing address
PO BOX 623, GUAYAMA, PR 00785-0623
(787) 866-3631
(787) 866-8690
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
04/03/2023
Last updated
06/15/2023
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