David Dominguez, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019031489 Issued in IL

Practice address

201 N Constitution Dr # 1
Aurora, IL 60506-3214

Phone

(630) 896-4516

NPI assigned

Jul 23, 2017

Last updated

Jan 9, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• D

  • Prison Health Clinic/Center
  • St Charles, IL
  • NPI 1902152846
  NPD (past)

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

{
    "created_epoch": "1500768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546992000000",
    "number": "1063935989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 LAKEVIEW DR",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605064444",
            "telephone_number": "630-715-5046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N CONSTITUTION DR # 1",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605063214",
            "telephone_number": "630-896-4516"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3825 Campton Hills Dr",
            "address_purpose": "LOCATION",
            "city": "St Charles",
            "state": "IL",
            "postal_code": "601756062",
            "country_code": "US",
            "telephone_number": "630-584-0506",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "157 S Lincoln Ave Ste C",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "IL",
            "postal_code": "605054291",
            "country_code": "US",
            "telephone_number": "630-859-0155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMINGUEZ",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-23",
        "last_updated": "2019-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019031489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019031489",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dolar R Koya MD SC
• Edwin Dolin, M.D.
• Sarah E Doll, PT
• Anna Maria Domalik, APRN
• Carmina Amor Tan Domingo, D.O.
• Jennifer Dominguez
• Karime Coletta Dominguez
• Donald C. Kellner DDS-Aurora PC
• Jesus G Donjuan
• Brett Donkin, PHARMD

• Dentist in Aurora, IL
• Providers in Aurora, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.