Provider Demographics
NPI:1730274978
Name:DOMINICI, JOHN T (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:DOMINICI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:625 BAYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-6607
Mailing Address - Country:US
Mailing Address - Phone:859-492-9633
Mailing Address - Fax:713-794-7640
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:160 OCL DENTAL
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-791-1414
Practice Address - Fax:713-794-7640
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62981223E0200X
IL1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223E0200XDental ProvidersDentistEndodontics
Not Answered1223P0700XDental ProvidersDentistProsthodontics