Provider Demographics
NPI:1194895144
Name:MCCARVER, DUSTIN EDWARD (LSA, SA-C, CSFA,)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:EDWARD
Last Name:MCCARVER
Suffix:
Gender:M
Credentials:LSA, SA-C, CSFA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE C106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6831
Mailing Address - Country:US
Mailing Address - Phone:972-566-5564
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LN STE C106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6831
Practice Address - Country:US
Practice Address - Phone:972-566-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TXSA00584246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical