Provider Demographics
NPI:1699730309
Name:DOMINIC SRESHTA , MD.,PA .
Entity type:Organization
Organization Name:DOMINIC SRESHTA , MD.,PA .
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SRESHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-778-9955
Mailing Address - Street 1:26 BERENGER PL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5658
Mailing Address - Country:US
Mailing Address - Phone:713-778-9955
Mailing Address - Fax:713-778-9969
Practice Address - Street 1:7737 SOUTHWEST FREEWAY # 800
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074
Practice Address - Country:US
Practice Address - Phone:713-778-9955
Practice Address - Fax:713-778-9969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0617207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty