| NPI | 1033765094 |
|---|---|
| Doing Business As | NORTHEAST CHILDREN'S DENTISTRY-DOMINION CROSSING LOCATION |
| Entity Type | Organization |
| Authorized Contact | TRACEY HAY Practice Coordinator 210-654-6882 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry |
| Enumeration Date | 2019-08-15 |
| Last Update Date | 2023-11-27 |