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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

DR. KERUSSO POOLEY DOMINGUEZ DDS
NPI 1841122462
Dentist - General Practice in Greensboro, NC

Active since May 29, 2026
4215 W WENDOVER AVE, GREENSBORO, NC 27407(336) 569-8669 Get Directions Write a Review

NPPES record last updated: June 29, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Dr. Kerusso Pooley Dominguez Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KERUSSO POOLEY DOMINGUEZ DDS (NPI 1841122462) is an individual general practice provider in Greensboro, North Carolina, licensed in North Carolina (14826) and active in the NPI registry since May 2026.

NPPES Registry Identity

NPI1841122462
Entity TypeIndividualMale
Primary Taxonomy1223G0001X
Provider Legal NameDR. KERUSSO POOLEY DOMINGUEZCredential: DDS
Location Address4215 W WENDOVER AVEGreensboro, NC 27407-1921
Mailing Address4215 W Wendover AveGreensboro, NC 27407-1921 · (336) 569-8669
Phone(336) 569-8669
Sole ProprietorNo
Enumeration DateMay 29, 2026
Last NPPES UpdateJune 29, 2026
NPPES CertifiedJune 29, 2026
✔ NPI 1841122462 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in NC · 14826
Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

4215 W WENDOVER AVE, Greensboro, NC 27407
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Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. MCCLARY & ASSOC. WENDOVER, P.A.
Dentist (General Practice)
4215 W WENDOVER AVE
GREENSBORO, NC 27407
Guilford County (336) 294-5020
DR. COLTEN LOUIS BUTLER DMD
Dentist
4215 W WENDOVER AVE
GREENSBORO, NC 27407
Guilford County (336) 294-5020
COLTEN BUTLER DMD PLLC
Clinic/Center (Dental)
4215 W WENDOVER AVE
GREENSBORO, NC 27407
Guilford County (336) 294-5020

Frequently Asked Questions

What is Kerusso Dominguez's NPI number?

The NPI number assigned to this healthcare provider is 1841122462, enumerated as an "individual" on May 29, 2026.

Where is the provider located?

The provider is located at 4215 W WENDOVER AVE GREENSBORO, NC 27407 and the phone number is (336) 569-8669.

What is the provider's specialty?

Dentist with taxonomy code 1223G0001X and a focus in General Practice.