Provider Demographics
NPI:1154722254
Name:DOMINGUEZ HILLS DENTAL GROUP
Entity type:Organization
Organization Name:DOMINGUEZ HILLS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-515-1490
Mailing Address - Street 1:20930 BONITA ST
Mailing Address - Street 2:SUITE T
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3680
Mailing Address - Country:US
Mailing Address - Phone:310-515-1490
Mailing Address - Fax:310-515-0032
Practice Address - Street 1:20930 BONITA ST
Practice Address - Street 2:SUITE T
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3680
Practice Address - Country:US
Practice Address - Phone:310-515-1490
Practice Address - Fax:310-515-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty