Provider Demographics
NPI:1841568813
Name:DOMINION PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:DOMINION PEDIATRIC DENTISTRY PLLC
Other - Org Name:DOMINION PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PREECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-491-4141
Mailing Address - Street 1:24165 IH 10 W
Mailing Address - Street 2:SUITE #121
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1159
Mailing Address - Country:US
Mailing Address - Phone:210-698-6143
Mailing Address - Fax:
Practice Address - Street 1:24165 IH 10 W
Practice Address - Street 2:SUITE #121
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1159
Practice Address - Country:US
Practice Address - Phone:210-698-6143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty