Individual
DR. ALYSSA MARIE DOMICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MS
Contact information
Practice address
2805 CAMPUS DR STE 245, PLYMOUTH, MN 55441-2678
(763) 383-1788
Mailing address
2805 CAMPUS DR STE 245, PLYMOUTH, MN 55441-2678
(763) 383-1788
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D14939
MN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D14939
MN
Other
Enumeration date
06/24/2021
Last updated
07/14/2024
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