Michael G. Dominov, DDS PC
Clinic/Center, Dental in Lee, MA. Organization (NPI-2).
NPI number1982803078
StatusActive
Last updated in NPPESJul 17, 2007
Details
- NPI
- 1982803078
- Entity type
- Organization (NPI-2)
- Legal business name
- Michael G. Dominov, DDS PC
- Organization subpart
- No
- Enumeration date
- Jul 17, 2007
- Last updated
- Jul 17, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | 16758 | MA | Yes |
Other names
- Lee Family Dentistry (Doing Business As)
Practice location
17 Franklin StLee, MA 01238-1629
Phone 413-243-0098 · Fax 413-243-2663
Mailing address
17 Franklin StLee, MA 01238-1629
Phone 413-243-0098 · Fax 413-243-2663
Authorized official
Michael George Dominov
President
4132430098
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