Individual
LORI CHRISTINA DOMINGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
575 SPRINGCREST DR, SUITE A, FORT MILL, SC 29715-7324
(803) 547-1888
(803) 547-8533
Mailing address
575 SPRINGCREST DR, SUITE A, FORT MILL, SC 29715-7324
(803) 547-1888
(803) 547-8533
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3850
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2X3850
—
SC
05
—
5900546
—
NC
Enumeration date
01/18/2006
Last updated
09/15/2023
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