Healthcare Provider Details

I. General information

NPI: 1366926297
Provider Name (Legal Business Name): DOMINANT RESIDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 MAC ARTHUR DR STE 101
CARROLLTON TX
75007-4437
US

IV. Provider business mailing address

1212 RIVERS CREEK LN
LITTLE ELM TX
75068-2907
US

V. Phone/Fax

Practice location:
  • Phone: 214-840-9157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347D00000X
TaxonomyTrain
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TEMISAN SMART
Title or Position: OWNER
Credential:
Phone: 214-840-9157