Individual
DUSTIN DEDOMENICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD MS
Contact information
Practice address
11012 N DALE MABRY HWY STE 302, TAMPA, FL 33618-3821
(813) 961-1414
Mailing address
11012 N DALE MABRY HWY STE 302, TAMPA, FL 33618-3821
(813) 961-1414
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
KY 9443
KY
1223P0221X
Pediatric Dentistry
Primary
DN20727
FL
Other
Enumeration date
04/07/2014
Last updated
09/24/2016
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