Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 2736 | RI |
NPI | 1659322725 |
---|---|
Provider Name | Erwin Joseph Domingo |
First Address | Woonsocket, RI 02895-4854 |
Second Address | Woonsocket, RI 02895-4854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2006 |
Last Update Date | 08/07/2007 |