Michael G. Dominov, DDS PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

16758 Issued in MA

Legal business name

MICHAEL G. DOMINOV, DDS PC

Practice address

17 Franklin St
Lee, MA 01238-1629

Phone

(413) 243-0098

Fax

(413) 243-2663

NPI assigned

Jul 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Michael George Dominov, DDSNPI 1619074267

Title

President

Phone

(413) 243-0098

Specialties & licenses 1

Addresses

Other names 1

• Lee Family Dentistry Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael George Dominov, DDS

  • General Practice Dentistry
  • Lee, MA
  • NPI 1619074267
  NPD (past) Authorized official

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

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184630400000",
    "number": "1982803078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 FRANKLIN ST",
            "city": "LEE",
            "state": "MA",
            "postal_code": "012381629",
            "telephone_number": "413-243-0098",
            "fax_number": "413-243-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 FRANKLIN ST",
            "city": "LEE",
            "state": "MA",
            "postal_code": "012381629",
            "telephone_number": "413-243-0098",
            "fax_number": "413-243-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL G. DOMINOV, DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-17",
        "last_updated": "2007-07-17",
        "status": "A",
        "authorized_official_last_name": "DOMINOV",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "413-243-0098",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MA",
            "license": "16758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lee Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kristin L McLaughlin, PHD
• Rachel Meczywor
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• Ashli Minor, RDN, LDN
• Chelsea J Mitchell, LCSW
• Patricia Molina
• Monroe Wheelchair Inc

• Dental Clinic/Center in Lee, MA
• Providers in Lee, MA by specialty
• Dental Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.