Paul Dominique, D.M.D.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN013383 Issued in GA

Practice address

16B Felton PL
Cartersville, GA 30120-2152

Phone

(770) 382-3536

Fax

(770) 382-1915

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Metadent Club LLC

  • General Practice Dentistry
  • Marietta, GA
  • NPI 1225981384
  NPD Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463356800000",
    "number": "1134227705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16B FELTON PL",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301202152",
            "telephone_number": "770-382-3536",
            "fax_number": "770-382-1915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16B FELTON PL",
            "city": "CARTERSVILLE",
            "state": "GA",
            "postal_code": "301202152",
            "telephone_number": "770-382-3536",
            "fax_number": "770-382-1915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOMINIQUE",
        "first_name": "PAUL",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2016-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN013383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diabetes and Endocrine Specialists LLC
• Douglas C Diruggiero Jr., PAC
• Michael-Vu DO, OD
• Andrea E Dobosz, OTR/L
• Aj Doh, RD, LD
• Isabelle Dominy, OTR/L
• Donald C. Evans, M.D., P.C.
• Dorinda Gail Donaldson, D.C
• Ann Marie Dougherty, M.S.
• Daniel R. Dougherty, M. A.

• Pediatric Dentistry in Cartersville, GA
• Providers in Cartersville, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; 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.