Provider Demographics
NPI:1215258025
Name:NAVARRO, DUSTIN (DMD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 SHELLY LN
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-7577
Mailing Address - Country:US
Mailing Address - Phone:208-490-6928
Mailing Address - Fax:
Practice Address - Street 1:2591 NW LOOP
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-1601
Practice Address - Country:US
Practice Address - Phone:208-490-6928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32598122300000X
AZD009584122300000X
ID43551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice