| Dominguez & Rucker Family Dentistry Llc | |
|
575 Springcrest Drive Suite A Fort Mill SC 29715-7307 | |
| (803) 547-1888 | |
| (803) 547-8533 |
| Full Name | Dominguez & Rucker Family Dentistry Llc |
|---|---|
| Speciality | Dentist |
| Location | 575 Springcrest Drive, Fort Mill, South Carolina |
| Authorized Official Name and Position | Lori C Dominguez (OWNER DENTIST) |
| Authorized Official Contact | 8035471888 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dominguez & Rucker Family Dentistry Llc 575 Springcrest Drive Suite A Fort Mill SC 29715-7307 Ph: (803) 547-1888 | Dominguez & Rucker Family Dentistry Llc 575 Springcrest Drive Suite A Fort Mill SC 29715-7307 Ph: (803) 547-1888 |
| NPI Number | 1508023649 |
|---|---|
| Provider Enumeration Date | 05/16/2008 |
| Last Update Date | 01/23/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508023649 | NPI | - | NPPES |
| ZX3850 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | SC3850 (South Carolina) | Primary |
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