| NPI | 1750977914 |
|---|---|
| Doing Business As | DOMINION DENTAL |
| Doing Business As | DOMINION DENTAL SPA |
| Entity Type | Organization |
| Authorized Contact | PERRY J BUSHONG President 817-851-3291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2020-12-11 |