| Dominion Dental Spa | |
|
4 Dominion Dr Ste 250 San Antonio TX 78257-1390 | |
| (210) 687-1150 | |
| Not Available |
| Full Name | Dominion Dental Spa |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 4 Dominion Dr Ste 250, San Antonio, Texas |
| Authorized Official Name and Position | Srikanth Cherukadu (OWNER) |
| Authorized Official Contact | 2106871150 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dominion Dental Spa 4 Dominion Dr Ste 250 San Antonio TX 78257-1390 Ph: (210) 687-1150 | Dominion Dental Spa 4 Dominion Dr Ste 250 San Antonio TX 78257-1390 Ph: (210) 687-1150 |
| NPI Number | 1881105948 |
|---|---|
| Provider Enumeration Date | 10/17/2017 |
| Last Update Date | 10/17/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881105948 | NPI | - | NPPES |
| 27122 | Other | TX | TEXAS DENTAL BOARD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 27122 (Texas) | Primary |
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