Organization
DOMINGUEZ & RUCKER FAMILY DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LORI C DOMINGUEZ DDS (OWNER DENTIST)
(803) 547-1888
Entity
Organization
Contact information
Practice address
575 SPRINGCREST DRIVE, SUITE A, FORT MILL, SC 29715-7307
(803) 547-1888
(803) 547-8533
Mailing address
575 SPRINGCREST DRIVE, SUITE A, FORT MILL, SC 29715-7307
(803) 547-1888
(803) 547-8533
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
SC3850
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZX3850
—
SC
Enumeration date
05/16/2008
Last updated
01/23/2017
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