Edward Dominguez, D.M.D
Individual provider Active NPI Dentist · Rutherford, NJ
NPI 1134579162 · NPPES record last updated Jun 21, 2016
Key facts
- NPI
- 1134579162
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 22DI02642300 (NJ)
- Practice address
- 201 Route 17
12TH Floor
Rutherford, NJ 07070-2574 - Phone
- (201) 549-8827
- NPI assigned
- Jun 21, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI02642300 | NJ | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI02642300 | NJ | Yes |
Addresses
Primary practice location
201 Route 17
12TH Floor
Rutherford, NJ 07070-2574
Mailing address
201 Route 17
12TH Floor
Rutherford, NJ 07070-2574
Phone (201) 549-8827
Other providers in Rutherford, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.