Dominguez Family Dental, CSP

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

DOMINGUEZ FAMILY DENTAL, CSP

Practice address

Calle Santiago Palmer 24 Sur
N/a
Guayama, PR 00784

Phone

(787) 866-3631

Fax

(787) 866-8690

NPI assigned

Apr 3, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ivelisse Dominguez Reveron, DMD

Title

President

Phone

(787) 678-7806

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Luis Alberto Dominguez Carrazquillo, DDS

  • General Practice Dentistry
  • Guayama, PR
  • NPI 1659379303
  NPD (past)
• Ivelisse Dominguez, DMD

  • General Practice Dentistry
  • Guayama, PR
  • NPI 1386098655
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686787200000",
    "number": "1023713740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 623",
            "city": "GUAYAMA",
            "state": "PR",
            "postal_code": "007850623",
            "telephone_number": "787-866-3631",
            "fax_number": "787-866-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "CALLE SANTIAGO PALMER 24 SUR",
            "address_2": "N/A",
            "city": "GUAYAMA",
            "state": "PR",
            "postal_code": "00784",
            "telephone_number": "787-866-3631",
            "fax_number": "787-866-8690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINGUEZ FAMILY DENTAL, CSP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-03",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "DOMINGUEZ REVERON",
        "authorized_official_first_name": "IVELISSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "787-678-7806",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Magda Iris Diaz Velazquez, O.D.
• Gladymar Diaz
• Jorge Amaro Diaz, M.S.W.
• Yesmarie Diaz, MS
• Luis Alberto Dominguez Carrazquillo, DDS
• Ivelisse Dominguez, DMD
• Dr Eduardo Nadal Ortiz Dba Arco Reflejo Grupo Medicina Fisica Y Rehab
• Dr. Carlos Acevedo Rego, C.S.P.
• Dr. Emilio Paez Chiropractic Center, PSC.
• Drellorens LLC

• General Practice Dentistry in Guayama, PR
• Providers in Guayama, PR by specialty
• General Practice Dentistry in Puerto Rico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.