Provider Demographics
NPI:1265613798
Name:LIRANZA DOMINGUEZ, ISABEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:
Last Name:LIRANZA DOMINGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 AVE BARBOSA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00925-3223
Mailing Address - Country:US
Mailing Address - Phone:787-764-8696
Mailing Address - Fax:787-756-8427
Practice Address - Street 1:1057 CALLE WILLIAM JONES
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925-3832
Practice Address - Country:US
Practice Address - Phone:787-764-8696
Practice Address - Fax:787-756-8427
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2016-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD2054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist