Dominic DO, M.S., D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

DN1858721 Issued in MA

Practice address

3001 Green Bay Rd
Uss Osborne
North Chicago, IL 60064

Phone

(443) 631-4923

NPI assigned

Aug 31, 2016

Sex

Male

Sole proprietor

Yes

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638662400000",
    "number": "1144776923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8370 ICE CRYSTAL DRIVE",
            "address_2": "A1",
            "city": "LAUREL",
            "state": "MD",
            "postal_code": "207232061",
            "telephone_number": "443-631-4923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 GREEN BAY RD",
            "address_2": "USS OSBORNE",
            "city": "NORTH CHICAGO",
            "state": "IL",
            "postal_code": "60064",
            "telephone_number": "443-631-4923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "DOMINIC",
        "name_prefix": "Dr.",
        "credential": "M.S., D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-08-31",
        "last_updated": "2021-12-05",
        "certification_date": "2021-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "16006",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "MA",
            "license": "DN1858721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald A Dignadice
• Qais Dihan
• Ralph Diprospero
• Yeny Rangel Nepomuceno Diwa
• Devin Dixit
• Dana Nicole Dolinko
• Ryan Andrew Dollins, C.T.R.S.
• Katherine Ellen Dong, M.A.
• Elizabeth Mary Donovan
• Annabelle Lee Dookie, DPM

• Endodontics in North Chicago, IL
• Providers in North Chicago, IL by specialty
• Endodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2021; 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.