Provider Demographics
NPI:1205718665
Name:CARRANZA, DOMINIQUE CELESTE (DDS)
Entity type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:CELESTE
Last Name:CARRANZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1871 ASHLEY RIVER RD APT 5110
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-8718
Mailing Address - Country:US
Mailing Address - Phone:916-705-4323
Mailing Address - Fax:
Practice Address - Street 1:29 BEE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403
Practice Address - Country:US
Practice Address - Phone:843-876-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist