Provider Demographics
NPI:1902412018
Name:CAVE SPRINGS DENTAL
Entity Type:Organization
Organization Name:CAVE SPRINGS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-949-2022
Mailing Address - Street 1:260 S GLENEAGLE DR STE C
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72718-6011
Mailing Address - Country:US
Mailing Address - Phone:479-282-1414
Mailing Address - Fax:
Practice Address - Street 1:260 S GLENEAGLE DR STE C
Practice Address - Street 2:
Practice Address - City:CAVE SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72718-6011
Practice Address - Country:US
Practice Address - Phone:479-282-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental