Individual
DR. DOMINADOR CO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
175 MADISON AVE, MOUNT HOLLY, NJ 08060-2038
(609) 914-6180
(609) 914-6182
Mailing address
401 ROUTE 73 N, 40 LAKE CENTER DRIVE, SUITE 201A, MARLTON, NJ 08053-3425
(856) 355-0340
(856) 355-0346
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
25MA04218400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0642509
—
NJ
Enumeration date
10/12/2005
Last updated
09/01/2010
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