Alyssa Marie Domico, DMD, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

D14939 Issued in MN

Practice address

2805 Campus Dr Ste 245
Plymouth, MN 55441-2678

Phone

(763) 383-1788

NPI assigned

Jun 24, 2021

Last updated

Jul 14, 2024By the provider in NPPES

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

Credentials

Master of Science

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.

• Camp Smile Orthodontics Excelsior PLLC

  • Dental Clinic/Center
  • Excelsior, MN
  • NPI 1548851090
  NPD (past)
• Camp Smile Pediatric Dentistry Excelsior PLLC

  dba Camp Smile Pediatric Dentistry

  • Pediatric Dentistry
  • Excelsior, MN
  • NPI 1467924290
  NPD (past)
• Collins Orthodontics, PA

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Rochester, MN
  • NPI 1700491545
  NPD (past)

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720915200000",
    "number": "1871162669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2805 CAMPUS DR STE 245",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412678",
            "telephone_number": "763-383-1788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2805 CAMPUS DR STE 245",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412678",
            "telephone_number": "763-383-1788"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "675 Water St Ste 2",
            "address_purpose": "LOCATION",
            "city": "Excelsior",
            "state": "MN",
            "postal_code": "553313072",
            "country_code": "US",
            "telephone_number": "952-242-9200",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7880 Main St N",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553697081",
            "country_code": "US",
            "telephone_number": "763-515-0011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOMICO",
        "first_name": "ALYSSA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-24",
        "last_updated": "2024-07-14",
        "certification_date": "2024-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D14939",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MN",
            "license": "D14939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Samantha Domagala
• Don Sealock, O.D., P.a. (Four Seasons Eyecare)
• Alicia Mae Donahue, LICSW
• Delaney Kyl Donohue, MT-BC
• Lisa Anne Doom, RN
• Michael Zetune Dorfman, LMFT

• Orthodontics and Dentofacial Orthopedics Dentistry in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2024; 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.