Katelyn Michelle Domingues, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02672401 Issued in NJ

Practice address

59 E Mill Rd Ste 2-2304
Long Valley, NJ 07853-6215

Phone

(908) 876-5225

Fax

(908) 876-1062

NPI assigned

Apr 26, 2016

Sex

Female

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

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

{
    "created_epoch": "1461628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1437504552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "59 E MILL RD STE 2-2304",
            "city": "LONG VALLEY",
            "state": "NJ",
            "postal_code": "078536215",
            "telephone_number": "908-876-5225",
            "fax_number": "908-876-1062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 E MILL RD STE 2-2304",
            "city": "LONG VALLEY",
            "state": "NJ",
            "postal_code": "078536215",
            "telephone_number": "908-876-5225",
            "fax_number": "908-876-1062"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Morristown",
            "state": "NJ",
            "postal_code": "079606136",
            "country_code": "US",
            "telephone_number": "973-971-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMINGUES",
        "first_name": "KATELYN",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-26",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NJ",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02672401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adam Todd Copestick, RNFA
• Mary Cutri-French, LCSW
• Noelle Deehan
• Sharon Defusco, MA, CCC-SLP
• Ashley Dombrowski, PSY.D.
• Ginger Downey, MS, CNS
• Christine E Drown, RD, CSR
• Robyn Baron Durst, MA, LPC
• Kira Aileen Ellis, DPT
• Ethos Primary Care PC

• General Practice Dentistry in Long Valley, NJ
• Providers in Long Valley, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.