Individual
AMBER BRIANNA DOMINQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
100 OLD CHEROKEE RD STE F, LEXINGTON, SC 29072-7959
(803) 808-2950
Mailing address
100 OLD CHEROKEE RD STE F, LEXINGTON, SC 29072-7959
(803) 808-2950
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
3709
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187113
—
SC
05
—
ZA9670 SC
—
SC
Enumeration date
07/27/2009
Last updated
07/27/2009
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