Provider Demographics
NPI:1497986970
Name:DOMINESSY, CYNTHIA LOUISE (DDS)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:DOMINESSY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 WEST COURT STREET
Mailing Address - Street 2:BUILDING A, SUITE #1
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695
Mailing Address - Country:US
Mailing Address - Phone:530-668-5343
Mailing Address - Fax:
Practice Address - Street 1:255 WEST COURT STREET
Practice Address - Street 2:BUILDING A, SUITE #1
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695
Practice Address - Country:US
Practice Address - Phone:530-668-5343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-02
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1024861223P0700X, 1223P0700X
CODEN-100081223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics