Individual
CORI JEANEL DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3740 COORS BLVD NW STE A, ALBUQUERQUE, NM 87120-4762
(505) 836-1280
Mailing address
13601 WENONAH AVE SE, ALBUQUERQUE, NM 87123-4187
(505) 205-0744
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD4695
NM
Other
Enumeration date
06/12/2017
Last updated
06/12/2017
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