Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 8911 | KY |
N | 204E00000X | Oral & Maxillofacial Surgeon | 8911 | KY |
NPI | 1538476775 |
---|---|
Provider Name | Dr. Enif A Dominguez Fernandez |
First Address | Lexington, KY 40536-0297 |
Second Address | Lexington, KY 40536-0297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2010 |
Last Update Date | 07/01/2015 |