Provider Demographics
NPI:1841503760
Name:D'SOUZA, SHEENA DOMINICA
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:DOMINICA
Last Name:D'SOUZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713S FLORES ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78214-2101
Mailing Address - Country:US
Mailing Address - Phone:210-922-7792
Mailing Address - Fax:
Practice Address - Street 1:5713S FLORES ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78214-2101
Practice Address - Country:US
Practice Address - Phone:210-922-7792
Practice Address - Fax:210-922-7333
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00257741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice