Provider Demographics
NPI:1356020333
Name:HART, DOMINICA DASHA (LSA)
Entity type:Individual
Prefix:
First Name:DOMINICA
Middle Name:DASHA
Last Name:HART
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 E 5TH ST STE 103-1011
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2533
Mailing Address - Country:US
Mailing Address - Phone:832-209-6458
Mailing Address - Fax:
Practice Address - Street 1:5304 E 5TH ST STE 103-1011
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2533
Practice Address - Country:US
Practice Address - Phone:832-209-6458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SA00979246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant