Individual
MRS. TARA DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1780 MARINE CORP. DRIVE, SANTA RITA, GU 96915
(671) 339-3175
Mailing address
PSC 455 BOX 171, FPO, AP 96540-0002
(671) 339-3175
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
D0084HY
GU
Other
Enumeration date
08/16/2023
Last updated
08/16/2023
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