Provider Demographics
NPI:1194349126
Name:SVATOS, DUSTIN OTTO (DDS)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:OTTO
Last Name:SVATOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 N 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-6160
Mailing Address - Country:US
Mailing Address - Phone:402-452-4745
Mailing Address - Fax:
Practice Address - Street 1:2612 W BROADWAY
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-3510
Practice Address - Country:US
Practice Address - Phone:712-323-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist