Individual
MR. EDWARD DOMINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8651 WEST 159TH STREET, SUITE 1, ORLAND PK, IL 60462
(708) 429-0900
(708) 460-8096
Mailing address
8651 WEST 159TH STREET, SUITE 1, ORLAND PK, IL 60462
(708) 429-0900
(708) 460-8096
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019A15355
IL
Other
Enumeration date
04/02/2007
Last updated
07/08/2007
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